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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610436
Report Date: 07/11/2026
Date Signed: 07/11/2026 12:39:49 PM

Document Has Been Signed on 07/11/2026 12:39 PM - 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:DAY & NIGHT ASSISTED LIVINGFACILITY NUMBER:
197610436
ADMINISTRATOR/
DIRECTOR:		MERI MKRTUMYANFACILITY TYPE:
740
ADDRESS:17655 NORDHOFF STREETTELEPHONE:
(747) 344-3314
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 6CENSUS: 6DATE:
07/11/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:34 AM
MET WITH:Karen Mesropyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:44 PM
NARRATIVE
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Licensing Program Analyst (LPA), Alberto Lopez, conducted an unannounced
annual visit. LPA was met by staff Barry Patnett. Administrator Karen Mesropyan arrived a short time later.

Infection Control: Facility has infection control plan, and no resident is currently infected with any infectious disease at the time of visit.
Operational Requirements: Facility showed proof of liability insurance that expires 03/13/2027

Physical Plant: There is a total of five (5) bedrooms. There is a bedroom designated for staff next to the kitchen on your left-hand side. There is a total of four (4) bedrooms for residents’ use. All the bedrooms have proper bedding, night stands, and lamps in addition to overhead lighting. Rooms did not have chairs for all residents. There is adequate supply of linen stored in the cabinets next to the bedrooms. There are (3) bathrooms. The facility has a working phone number and land line. Fire Extinguisher is located near kitchen door on your left-hand side on the floor. It is fully charged and was last checked on 04/25/2025

Kitchen: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Food supply adequate stored in several cabinets and consists of the following cereal, canned goods, bottles of water. Dishwasher in kitchen properly installed and functioning. The refrigerator is in good condition and working. There were dead insects inside the refrigerator and promptly clean. There are smoke detectors/carbon monoxide throughout the house that were tested and work properly. They are hardwired and interconnected. There is also one in each room. The water temperature was tested for the bathrooms and are within regulation -112.5 -117.0 Fahrenheit. (Continued)

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 14
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: DAY & NIGHT ASSISTED LIVING
FACILITY NUMBER: 197610436
VISIT DATE: 07/11/2026
NARRATIVE
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(Continued from 809)

Staffing: Facility staff are all over 21 years of age.

Personnel Records/Staff Training: Three staff files were reviewed and two (2) of three (3) are missing CPR certificate and all three 2 of 3 staff are missing proof of ongoing training.

Planned Activities: Facility has enough space for indoor and outdoor activities. Most residents were watching TV at time of visit.

Food Service: There appears to be enough food for 2-day perishable and 7 day non-perishable

Incidental Medical and Dental: Medication list for 3 residents was not available for review during visit. One resident had timed medication in bottle that should have been empty by 07/07/2026. One resident was missing D/C orders for all medications as administrator stated it was discontinued.

Resident Rights/Information: Resident rights are in the resident files reviewed and facility has required signs posted.

Resident Records/Incident Report: Facility was in compliance during the visit.

Disaster Preparedness: LIC 602 needs to be updated to reflect staff responsible for assignment during emergencies. Facility did not have proof of current fire or emergency drill.

Residents with Special Health Needs: Facility does not have any residents with special health needs per Administrator

An exit interview was conducted, several citations were issued, technical violations issue, appeals rights and a copy of this report was given to the administrator.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2026
LIC809 (FAS) - (06/04)
Page: 3 of 14
Document Has Been Signed on 07/11/2026 12:39 PM - It Cannot Be Edited


Created By: Alberto Lopez On 07/11/2026 at 11:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DAY & NIGHT ASSISTED LIVING
FACILITY NUMBER: 197610436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87415(a)
Night Supervision
(a) The following persons providing night supervision from 10:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services, and shall be available as indicated below to assist in caring for residents in the event of an emergency:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation. nterview, record review, the licensee did not comply with the section cited above. 2 of 3 staff did not have current CPR/first aid certificates. ] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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Administrator will obtain CPR/first aid certificate for all staff and sent to LPA by POC date.
Type B
Section Cited
CCR
87412(f)
Personnel Records
(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. 3 of 6 residents files where not at facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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Administrator will send proof that the 3 residents files are at facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Alberto Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2026


LIC809 (FAS) - (06/04)
Page: 4 of 14
Document Has Been Signed on 07/11/2026 12:39 PM - It Cannot Be Edited


Created By: Alberto Lopez On 07/11/2026 at 11:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DAY & NIGHT ASSISTED LIVING
FACILITY NUMBER: 197610436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(c)(4)
Other Provisions
(c) The training shall include, but not be limited to, all of the following: (4) Policies and procedures regarding medications.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. 2 of 3 staff had no proof of medication administrating which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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3
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Administrator will send proof of ongoing medication training to LPA by POC date,
Type B
Section Cited
CCR
87555(b)(27)
General Food Service Requirements
(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observe dead insects in refrigerator which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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Administrator will clean refrigerator of all insects and send proof to LPA by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Alberto Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2026


LIC809 (FAS) - (06/04)
Page: 5 of 14
Document Has Been Signed on 07/11/2026 12:39 PM - It Cannot Be Edited


Created By: Alberto Lopez On 07/11/2026 at 11:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DAY & NIGHT ASSISTED LIVING
FACILITY NUMBER: 197610436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(a)(5)(A)
Incidental Medical and Dental Care Services
(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation, and record review the licensee did not comply with the section cited above. Resident 3, 4, and 5 did not have medication record to reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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Administrator will send proof that all resident's have medication records to review.
Type B
Section Cited
CCR
87465(a)(6)
Incidental Medical and Dental Care Services
(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review)], the licensee did not comply with the section cited above, No doctor's orders for medications for R3,4,5.which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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Administrator will send proof of correction to LPA by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Alberto Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2026


LIC809 (FAS) - (06/04)
Page: 6 of 14
Document Has Been Signed on 07/11/2026 12:39 PM - It Cannot Be Edited


Created By: Alberto Lopez On 07/11/2026 at 11:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DAY & NIGHT ASSISTED LIVING
FACILITY NUMBER: 197610436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(c)(1)
Incidental Medical and Dental Care Services
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information specified in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication of when the physician should be contacted for a medication reevaluation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation and record review, the licensee did not comply with the section cited above. No DC orders for R1. according to administrator, all his medications have been discontinued which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
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2
3
4
Administrator will send proof that all medications have been discontinued for R1 and send to LPA proof,
Incidental Medical and Dental Care Services

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Alberto Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2026


LIC809 (FAS) - (06/04)
Page: 7 of 14
Document Has Been Signed on 07/11/2026 12:39 PM - It Cannot Be Edited


Created By: Alberto Lopez On 07/11/2026 at 11:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DAY & NIGHT ASSISTED LIVING
FACILITY NUMBER: 197610436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87506(a)
Resident Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above. Three resident files where not at facility for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2026
Plan of Correction
1
2
3
4
Administrator will send proof that the resident files are at facility,
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Hicks
NAME OF LICENSING PROGRAM MANAGER:
Alberto Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2026


LIC809 (FAS) - (06/04)
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