195850709-6-15-2026-29-AS-CYEE-DV422Z-20260615170133

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850709
Report Date: 06/15/2026
Date Signed: 06/15/2026 05:02:19 PM

Document Has Been Signed on 06/15/2026 05:02 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	LOVE IS US 1		FACILITY NUMBER:	195850709
ADMINISTRATOR/ DIRECTOR:	GHAZARYAN, ANI		FACILITY TYPE:	740
ADDRESS:	14625 LEADWELL STREET		TELEPHONE:	(818) 397-3456
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY: 6		CENSUS: 0	DATE:	06/15/2026
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Ani Ghazaryan, Applicant/Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:15 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	Licensing Program Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit and met with Ani Ghazaryan, Applicant/Administrator. Today's visit was conducted using the CARE Inspection Tool. The facility is a single storey family home consisting of a living room, dining room, kitchen, 3 bedrooms and 2 full bathrooms. The facility is fire cleared for six (6) NON-AMBULATORY residents only. Per the Applicant, she requested a hospice waiver for 6 residents. All 12 domains of the CARE Inspection Tool was reviewed on today's visit. Also reviewed were the Emergency and Disaster Plan for Residential Care Facilities for the Elderly and Residential Infection Control Plan. Component IIII was conducted with Ani Ghazaryan, Applicant/Administrator The following was observed on today's visit: The living room was observed with a L-shaped sofa capable of seating 6 residents, ottoman, mounted television and a television stand. Board games were stored in the ottoman. The dining room had a dining table and 6 chairs. Also observed in the dining room was the only fire extinguisher, purchased on 3/16/26. The kitchen is equipped with a gas stove with an oven, a dishwasher, refrigerator, microwave, toaster continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOVE IS US 1	FACILITY NUMBER: 195850709
	VISIT DATE: 06/15/2026

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and coffee maker. Plenty of silverware, plates, cups and drinking glasses, pots and pans were observed. Sufficient non-perishable foods were observed for seven days and perishable foods for a minimum of 2 days will be purchased prior to accepting the first resident. Drinking water was observed in an outside storage shed located in the back. Water temperature tested in the kitchen read 107.6 degrees Fahrenheit.
Medications will be centrally stored in a locked kitchen cabinet located by the food pantry. Also stored in the cabinet will be the first aid kit and manual.
Cleaning solutions are stored in a locked cabinet under the kitchen sink, in the outside shed and in the locked cupboard located in the common bathroom.
Bedroom #1 located on the left of the hallway, Bedroom #2 located to the right of the hallway and bedroom #3 located in the back left were all observed with 2 each: beds, night stands, lamps, chairs and one each: dresser and a built in closet. Each room is also equipped with a mounted television. Sufficient bed linens, blankets and towels were observed in the closets of each room.
The bedroom windows were covered with blinds.
The common bathroom is equipped with a single sink vanity, a toilet and a walk in shower. Grab bars were observed in the shower and behind the toilet. A slip resistant mat was also observed. Water temperature was tested and read 107.8 degrees Fahrenheit.
The private bathroom is equipped with a 2 sink vanity, a walk in shower and a toilet. Grab bars and a slip resistant mat was observed. Water temperature was tested and read 107.6 degrees Fahrenheit.
Located above the fire rated door from the living room and the resident hallway are hardwired carbon monoxide detectors. Smoke detectors also hardwired, are located in the 3 bedrooms. The smoke detectors and carbon monoxide detectors were tested and were operational.
Auditory devices mounted on the 2 outside exiting doors located in the front and in the back were operational
Per tour of the enclosed backyard, a table with 6 chairs were observed under a tent for outside activities. A storage shed was also observed. The enclosed backyard has a self latching gate on each side of the home. The gates are mounted with auditory devices.

continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026

LIC809 (FAS) - (06/04)

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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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOVE IS US 1	FACILITY NUMBER: 195850709
	VISIT DATE: 06/15/2026

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the trash cans were observed to be tightly sealed.
the front yard is used for parking vehicles.
The facility, backyard and front yard were observed to be clean and well maintained.

The following needs to be corrected prior to licensure:

the fire rated door needs to be adjusted so that it closes tightly when the smoke detectors are triggered
a pair of scissors needs to be placed in the first aid kit
the Emergency and Disaster Plan needs to be reviewed and updated to include more appropriate relocation sites and more details provided
develop a facility policy for guns
develop a facility policy for internet use
post the facility's visiting hours
update the facility sketch to include the assembly point and the locations of the gas, water and electric shut off valves.

The Applicant will notify LPA Yee once the above corrections have been completed.

The Applicant will also ensure to complete the following upon Licensure:

purchase general liability in the amount of $1 million per occurrence and $3 million total annual aggregate
create staff, volunteers and resident files as required by Section 87412 Personnel Records and Section 87506 Resident Records
ensure that all staff have received a criminal record clearance and have requested a criminal record clearance transfer to the facility prior to being present at the facility
Purchase perishable foods for a minimum of 2 days prior to accepting the first resident.

Exit interview was conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026

LIC809 (FAS) - (06/04)

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