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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610320
Report Date: 08/13/2025
Date Signed: 08/13/2025 10:57:40 AM

Document Has Been Signed on 08/13/2025 10:57 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:WINNETKA HOME CAREFACILITY NUMBER:
197610320
ADMINISTRATOR/
DIRECTOR:		HARUTUNYAN, ALLAFACILITY TYPE:
740
ADDRESS:19733 HEMMINGWAY STTELEPHONE:
(818) 434-9916
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 6CENSUS: 5DATE:
08/13/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Alla Harutunyan - Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Manager (LPM) Nichelle Gillyard and Licensing Program Analyst (LPA) Perchui Melina Khurshudyan met with Administrator/President Alla Harutunyan for an informal office visit.

The purpose of the office visit is to discuss the current operation of this facility and to clarify requirements.

On 08-06-2025 LPA Khurshudyan conducted a case management visit to do a wellness check on a recent resident that was admitted. During the visit LPA was made aware that the facility had been sold. The department did not receive a letter of intent to sale which will result in the issuance of a new license, per health and safety code 1569.191.

LPA completed a CCL file review and contacted the county assessor’s office. LPA found that in June 2025 the property was sold. The Administrator did not notify the department nor submit a lease-back agreement with the new property owner until the LPA addressed it with Mrs. Harutunyan.

During the Informal Meeting, Licensing Program Manager (LPM) Nichelle Gillyard reminded current Licensee/Administrator Mrs. Harutunyan that until the new CHOW – Change of Ownership application process is complete, and a new license is issued, the current licensee/administrator retains full responsibility for the operation of the facility. This includes ensuring compliance with all applicable laws and regulations. Copy of Health and Safety Code 1569.191 was provided to the Licensee/Administrator.

Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WINNETKA HOME CARE
FACILITY NUMBER: 197610320
VISIT DATE: 08/13/2025
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According to the Administrator/President there was intent to sell. She is trying out potential owner as staff to see if they would be a fit. During the meeting a letter of intent was submitted. She will notify LPA if she decides not to go through with it. The administrator was very apologetic and didn't realize the requirements to notify for intent to sell. Also during the visit we discussed criminal record clearance. Two staff were not associated to the facility. LPA collected documentation for Mr. Kapikyan. The department will submit for association. Documentation for the other staff will be submitted today. LPM reminded the Administrator that staff shall not have presence or work in a facility until fingerprint cleared and associated. LPA collected a copy of the new lease which will be added to the folder.

Licensing Program Analyst (LPA) Perchui Milena Khurshudyan requested and collected the following document:

New lease agreement between the Licensee and the new owner of the property.

Intent to Sell letter issued for the Dept. of Social Services – CCL, and for residents currently residing at the facility.

LIC9182 - for the new Staff/Caregivers Licensee will email copies to LPA.

Copies of IDs for the new Staff/Caregivers.

Exit interview conducted copy of this report signed and delivered.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC809 (FAS) - (06/04)
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