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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850401
Report Date: 02/12/2026
Date Signed: 02/12/2026 09:03:40 PM

Document Has Been Signed on 02/12/2026 09:03 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:PRESTIGE RESIDENTIAL CARE FACILITYFACILITY NUMBER:
195850401
ADMINISTRATOR/
DIRECTOR:		SADOYAN, NELLIFACILITY TYPE:
740
ADDRESS:6019 WILLOWCREST AVETELEPHONE:
(818) 429-9809
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 5CENSUS: 5DATE:
02/12/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:57 AM
MET WITH:Nelli Sadoyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
09:10 PM
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the CARE Inspection Tool and was let into the home by Eleanora Gabrielyan, Staff. Staff contacted Nelli Sadoyan, Administrator, by telephone and she arrived to conduct the visit at 10:27am. The reason for today's visit was provided.

The facility is a single storey family home consisting of a living room, dining room, kitchen, 3 resident bedrooms, an office, 2.5 bathrooms and a detached garage. The facility is fire cleared for 2 AMBULATORY, 2 NON-AMBULATORY and 1 BEDRIDDEN resident. The facility has an approved hospice waiver for 5.

On today's visit, all 12 domains of the CARE Inspection Tool, 5 resident files and 3 staff files were reviewed. A tour of the entire facility, inside and outside, was conducted. The following was observed:
  • the living room, dining room and kitchen were all furnished and equipped with the appropriate furniture and equipment for its designated use. The fire place in the living room was sealed with a fire screen.
  • Bedroom #1 is a single room and Bedroom #2 and Bedroom #3 are shared rooms. All bedrooms were furnished with a bed, a night stand, a lamp, a dresser, a chair and a built in closet in bedroom #1 and bedroom #3. Bedroom #2 has portable closet.
  • Bed linens were observed in the hallway and towels in the common bathroom closet.
  • The common bathroom is equipped with tub, a toilet, shower chair and a sink. The water temperature tested 100.1 degrees Fahrenheit. The private bathroom inside bedroom #2 is equipped with a walk in shower, a toilet and a sink and a shower chair. The water tested 101.4 degrees Fahrenheit. The back bathroom just has a walk in shower with a shower chair. All 3 bathrooms have grab baths and slip
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2026
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.

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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: PRESTIGE RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 195850401
VISIT DATE: 02/12/2026
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  • resistant mats.
  • The hardwired smoke detectors located in the resident bedrooms, living rooms, hallway and the only combination smoke/carbon monoxide detector located in the hallway located by bedroom #3 were all tested and were operational.
  • The auditory device located on the front door and the back door located in bedroom #2 were operational.
  • The first aid kit was reviewed and contained a scissors, tweezer and a thermometer. A first aid manual was also observed.
  • The facility has current general liability insurance that meets Title 22 requirements.
  • The food was reviewed and sufficient perishable foods for a minimum of 2 days and insufficient non-perishable foods for a minimum of 7 days was observed. The facility has purchased 2 emergency food kits for non-perishable foods.
  • The only fire extinguisher located in the dining room was purchased on 2/5/25 and was observed to be full.
  • The front yard was observed with an umbrella and chairs for activities.
  • The enclosed back yard was observed to be clean.
  • Per review of the files, Staff have current First aid training. The Administrator and the house manager do not have current CPR training, Eleonora Gabrielyan, Staff has current CPR training and was present at the facility.
  • LPA Yee will clarify the fire rated door installed in the resident hallway and will address any deficiencies related to the doors on a return visit if needed.


Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Any deficiencies not addressed on today's visit will be addressed on a return visit.

Exit interview was conducted, Appeal Rights were discussed and a copy was provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 02/12/2026 09:03 PM - It Cannot Be Edited


Created By: Christine Yee On 02/12/2026 at 08:05 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PRESTIGE RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 195850401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87555(b)(26)
General Food Service Requirements
(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation, the licensee did not comply with the section cited above as it was observed that there was insufficient non-perishable foods observed on site. The facility has emergency food kits instead which oses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/13/2026
Plan of Correction
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2
3
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The Licensee will purchase non-perishable foods in quantities to last a minimum of 7 days and maintain on the premises and provide evidence by 2/13/26
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
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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.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2026


LIC809 (FAS) - (06/04)
Page: 4 of 10
Document Has Been Signed on 02/12/2026 09:03 PM - It Cannot Be Edited


Created By: Christine Yee On 02/12/2026 at 08:05 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PRESTIGE RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 195850401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

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 as the water tested in the common bathroom read 100.1 degrees and in the private bathroom read 101.4 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/13/2026
Plan of Correction
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The Licensee will adjust the theromstat on the water heater to ensure that the water temperature attains a temperature range within 105 to 120 degree Fahrenheit. Evidence of the correction will be provided by 2/13/26.
Type B
Section Cited
CCR
87465(b)
Incidental Medical and Dental Care Services
(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication.

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 as Resident #1, Resident #2, Resident #4 and Resident #5 have PRN medications and do not have completed PRN Authorization Letters for the medications on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2026
Plan of Correction
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The Licensee will contact all prescribing doctors of the PRN medications to obtain PRN Authorization letters for all residents who have PRN medications and maintain in the resident's file.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2026


LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 02/12/2026 09:03 PM - It Cannot Be Edited


Created By: Christine Yee On 02/12/2026 at 08:05 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PRESTIGE RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 195850401

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(c)(3)
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: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.

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 4 out of 5 residents who have PRN medications and do not keep a record of the date and time the PRN medication was taken, the dosage taken and the resident's response which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2026
Plan of Correction
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The Licensee will read Title 22, Section 87465 - Incidental Medical and Dental Care and submit a written statement that they have read the section and understand the requirements and will adhere to the requirements of the section. Provide written statement by 2/19/26.
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.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2026


LIC809 (FAS) - (06/04)
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