197610969-6-17-2026-31-AS-AAEA-DV5T3U-20260617142255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610969
Report Date: 06/17/2026
Date Signed: 06/17/2026 02:23:06 PM

Document Has Been Signed on 06/17/2026 02:23 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:	S&K CARE CENTER		FACILITY NUMBER:	197610969
ADMINISTRATOR/ DIRECTOR:	GHEVONDYAN, ZHENYA		FACILITY TYPE:	740
ADDRESS:	11338 LULL STREET		TELEPHONE:	(747) 767-0076
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY: 6		CENSUS: 0	DATE:	06/17/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Assist Administrator/CEO, Knarik Horsepyan		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 10:00a.m., Licensing Program Analyst (LPA), Antonia Alvizar-Ettima conducted an announced Pre - Licensing visit to the above facility and met with Assistant Administrator/CEO. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL).Fire Clearance was approved on 12/04/25 for a maximum capacity of six (6) non – ambulatory residence age range 60 and over. The purpose of today’s visit is to inspect the facility to ensure that the physical plant is in compliance with rules and regulations of California Code of Regulations, Title 22, Division 6, Chapter 8. The facility is a single-story building in a residential community. The facility has two (2) fully charged fire extinguishers, located in the entrance and dining area. Fire extinguishers receipt dated June 16, 26. Emergency exit plan/sketch is posted on the entrance wall along with other posting requirements. Additional emergency exit plan/sketch are posted in each bedroom. Telephone (818) 210-0066 land line is operable. LPA utilized Compliance and Regulatory Enforcement (CARE) tools. A tour of the physical plant inside an outside was initiated at approximately 10:50a.m., and the following was observed: KITCHEN: The facility has a kitchen area that is equipped with a sink, stove, microwave, dishwasher and two (2) refrigerators. The kitchen food preparation was observed to be sanitary. No perishable food currently however, a supply of nonperishable and emergency food in kitchen cabinets. There was dinnerware present to accommodate a maximum capacity of six (6) residents. All knives and sharps are observed to be locked in a drawer in the kitchen and inaccessible to residents. Cont. on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

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: S&K CARE CENTER	FACILITY NUMBER: 197610969
	VISIT DATE: 06/17/2026

NARRATIVE

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Cont. from LIC 809

BEDROOMS: There are three (3) shared bedrooms. All residents’ bedrooms are furnished with bed, chair, nightstand, dresser and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. BATHROOMS: LPA inspected the bathrooms they are clean and in excellent condition. LPA observed two (2) full bathrooms with grab bars and non-skid mats for residents and staff to use. Water temperature was within regulation ranging between 110.9°F – 111.4°F. LPA also observed sufficient quantity of toilet papers, soap and paper towels. COMMON AREAS: The facility maintains a comfortable temperature at 76°F. The living room has a television, couches, magazines, coloring books and board games. The dining area has a table with six (6) chairs that were clean and properly furnished. OFFICE SPACE: The medication and first aid kit will be stored in a locked cabinet inaccessible to residents. Staff and residents’ records will be maintained in a locked metal filing cabinet inaccessible to residents. LAUNDRY SPACE: The laundry space is located next to kitchen; the washer and dryer were in working condition at the time of the visit. Laundry detergents and cleaning supplies were observed stored in the laundry space inaccessible to residents.
SMOKE DETECTORS/CARBON MONOXIDE. Dual smoke detectors and carbon monoxide were located in the bedrooms and throughout the facility. They were tested and observed to be operational
EMERGENCY LIGHT: Emergency lighting was observed installed and operational in the facility in each room and throughout the facility.
SURROUNDING GROUNDS: The facility grounds were well maintained and enclosed. The passageways and entrance to the facility were clear of obstruction. Entry and exit doors have a functional auditory alert when the doors open at the time of visit. LPA observed appropriate outdoor furniture and sufficient shaded yard area for residents. LPA discussed the importance of maintaining care and supervision to meet the needs of residents. The facility has no garage or body of water.
Component III: Assist Administrator/CEO, Knarik Horsepyan completed Component III during today’s pre-licensing visit and acknowledged understanding.
Based on inspection and observation, the physical plant is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB), and the applicant will be notified by the CAB Analyst when your license has been approved.

Exit interview was conducted and a copy of this report was provided to Assistant Administrator/CEO.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Antonia Alvizar-Ettima
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC809 (FAS) - (06/04)

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