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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610337
Report Date: 06/02/2026
Date Signed: 06/02/2026 01:21:03 PM

Document Has Been Signed on 06/02/2026 01:21 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:NH CARE, LLCFACILITY NUMBER:
197610337
ADMINISTRATOR/
DIRECTOR:		KOSOYAN, GRIGORFACILITY TYPE:
740
ADDRESS:15757 SEPTO STREETTELEPHONE:
(818) 919-9181
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 5DATE:
06/02/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Grigor Kosoyan, Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 6/02/26, 8:30AM Licensing Program Analyst (LPA) Raymond Comer conducted an unannounced annual visit to this facility. LPA met with the Assistant Administrator, Girgor Kosoyan, and reason for the visit was discussed.

Facility is licensed as a single-story residence; fire clearance is licensed for six (6) total residents. One (1) resident may be non-ambulatory, and one (1) resident may be bedridden in bedroom# 3. Facility has a total of three (3) bedrooms, and two (2) bathrooms for residents’ use.

At 8:45AM, LPA conducted a tour of the physical plant with the Administrator and observed the following:

Physical plant: was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, and other necessary signage are posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 74.0°F. within the required range. Required postings are prominently displayed and observed to be current. Passageways and entrance were clear of obstruction. Disaster drills were last conducted on 3/15/2026.

[LIC809C] Continued-
NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2026
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: NH CARE, LLC
FACILITY NUMBER: 197610337
VISIT DATE: 06/02/2026
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Fire detection system: is present in the facility. Smoke detectors and Carbon Monoxide detectors were tested and working as operable at the time of visit. LPA observed one (1) fire extinguisher located in the kitchen area; purchase/service Date: 11/21/2025.

Kitchen: At 9:355 AM LPA observed kitchen as clean, equipped with stove, refrigerator, microwave oven, and multiple appliances. LPA observed an adequate supply of perishables and non-perishable food available for residents; food was observed as properly labeled and stored. Facility’s freezer is stocked with frozen foods, including meats and vegetables. Knives and sharps are stored and locked in a kitchen drawer and are inaccessible to residents. Toxins are stored and locked under the kitchen sink.

Medications: observed stored in a locked upper kitchen cabinet and inaccessible to residents. Facility has fully stocked first aid kit and manual located in the medication cabinet.



Laundry: LPA observed the laundry area located in outdoor storage; appliances were observed to be functional. Laundry soaps, and other cleaning agents are secured in the laundry shed and inaccessible for residents. Linen storage observed maintaining an adequate supply of linens and towels and bed sheets.

Garage: There is no garage at the facility.

Commons: LPA observed all common areas of the facility. (Living room and dining room area) LPA observed common areas to be clean, organized, properly furnished and in good condition. Dining room table and seating sufficient to accommodate all residents.

Bedrooms were observed as clean, with sufficient closet space, lighting, properly furnished with bedding, linens, dressers, at least one chair, and night stand.

Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 118.0°F. Within the required range.

[LIC809C] Continued-

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: NH CARE, LLC
FACILITY NUMBER: 197610337
VISIT DATE: 06/02/2026
NARRATIVE
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Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. There are two (2) sheds used for storage were observed as locked, and inaccessible to residents. Outdoor area observed as clean and clear from obstruction. No bodies of water are located on the premises.

Resident records: Records were stored in staff office; LPA observed office as locked and inaccessible to residents. A total of five (5) resident files were reviewed for current IPP and/or Needs and Services plans, physician report, admission agreements and other related documentation. No appraisal was found in reviewed records for for R1, R3, R4 and R5. No Tuberculosis read/results tests was found in reviewed records for R1, R2, R3, R4. No Physican's assessment report was found in reviewed file for R2. Deficiency will be cited on LIC 809-D.



Staff records: Records were stored in staff office; LPA observed office as locked and inaccessible to residents. A total of three (3) Staff files were reviewed. Criminal record clearances were present, and staff are associated to this facility; Staff records appear to be complete and current.

Exit interview was conducted and a copy of this report and deficiency report was provided to the assistant administrator.
NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/02/2026 01:21 PM - It Cannot Be Edited


Created By: Raymond Comer On 06/02/2026 at 12:42 PM
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: NH CARE, LLC
FACILITY NUMBER: 197610337

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87458(c)(1)
Medical Assessment
(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one (1) out of five (5) total resident files which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/16/2026
Plan of Correction
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Licensee will arrange to obtain a completed physician's report for resident#2 (R2) and submit proof of reciept by the POC due date.
Type A
Section Cited
CCR
87458(c)(1)(A)
Medical Assessment
(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in four (4) out of five (5) resident files found without required tuberculosis testing and results which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/16/2026
Plan of Correction
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Licensee will provide proof/arrange for a TB test for the resident and submit proof of negative test by the POC due 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.
Naira Margaryan
NAME OF LICENSING PROGRAM MANAGER:
Raymond Comer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/02/2026 01:21 PM - It Cannot Be Edited


Created By: Raymond Comer On 06/02/2026 at 12:43 PM
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: NH CARE, LLC
FACILITY NUMBER: 197610337

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87463(a)
Reappraisals
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in four (4) out of five (5) total resident files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2026
Plan of Correction
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For all residents, Licensee shall provide proof of updated and accurate Appraisals in writing by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Naira Margaryan
NAME OF LICENSING PROGRAM MANAGER:
Raymond Comer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2026


LIC809 (FAS) - (06/04)
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