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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850497
Report Date: 09/04/2025
Date Signed: 09/04/2025 01:01:13 PM

Document Has Been Signed on 09/04/2025 01:01 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:VALLEY'S BEST HOMECAREFACILITY NUMBER:
195850497
ADMINISTRATOR/
DIRECTOR:		KUYUMCHYAN, GAMLETFACILITY TYPE:
740
ADDRESS:6236 HALBRENT AVENUETELEPHONE:
(818) 472-9945
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY: 6CENSUS: DATE:
09/04/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:56 AM
MET WITH:Gamlet KuyumchyanTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Trevor Byrne conducted an initial complaint visit for the above allegation. LPA arrived to the facility at 09:57 AM. LPA met with the facility staff who contacted the Administrator Gamlet Kuyumchyan. The facility Designee Liana Atabekyan arrived to the facility at 10:16 AM and the Administrator arrived shortly after. Entrance interview conducted and the reason for the visit was explained.

During today’s visit, the LPA conducted a brief physical plant tour to ensure there are no health and safety hazards, interviewed the Designee, conducted a file review for five (5) residents and collected copies of pertinent documents between 10:16 AM. and 12:43 PM.

During the visit LPA was informed by the facility Designee that resident #1 (R1) was recently hospitalized on 08/26/2025. LPA reviewed the facility file and did not observe an incident report submitted for the hospitalization of R1. LPA interviewed the Designee and asked why an incident report was not submitted. The Designee informed LPA that they were working on completing the incident report but have not had a chance to submit the report to Community Care Licensing Division (CCLD) yet. LPA informed the Designee that any incident which threatens the welfare, safety or health of any resident must be submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of the event. The Designee expressed understanding and agreed to submit the incident report to CCLD as soon as possible.

Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2025
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: VALLEY'S BEST HOMECARE
FACILITY NUMBER: 195850497
VISIT DATE: 09/04/2025
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During the visit LPA was informed by the Designee that R1 is a recipient of home health services. LPA reviewed R1’s file and did not observe any record of R1 being enrolled in or receiving home health services. LPA interviewed the Designee and asked why there was no record of R1 being enrolled in home health stored in their file. The Designee informed LPA that home health would not release the documents to the facility without consent from R1 or R1’s responsible party (RP). LPA asked if the facility had requested consent from R1 or R1’s RP. The Designee stated that they had not asked previously. LPA informed the Designee that home health may only be utilized if the licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical conditions. Additionally, the written agreement shall be signed by the licensee or licensee representative, and representative of the home health agency, and placed in the resident’s file. The Designee expressed understanding and obtained consent from R1’s RP to release the home health documents to the facility at the time of the visit.

During file review LPA observed Resident #2’s (R2) file. LPA observed R2’s file to be missing a completed physician’s report. LPA interviewed the Designee who stated that R2 was recently admitted to the facility yesterday (09/03/2025). The Designee stated that they were waiting on R2’s family to complete their physician report and the facility currently does not have a completed physician report for R2. LPA informed the Designee that prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year. The Designee expressed understanding and agreed to obtain a completed medical assessment and send proof of the completed assessment to CCLD as soon as possible.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/04/2025 01:01 PM - It Cannot Be Edited


Created By: Trevor Byrne On 09/04/2025 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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY'S BEST HOMECARE
FACILITY NUMBER: 195850497

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2025
Section Cited
CCR
87211(a)(1)(D)

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87211 Reporting Requirements
(a) ...licensee shall furnish...such reports...
(1) A written report shall be submitted... within seven days of the occurrence...
(D) Any incident which threatens the welfare, safety or health of any resident...
This requirement is not met as evidenced by:
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Facility Designee agreed to submit the incident report for R1's hospitalization to CCLD no later than POC due date.
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Based on interview and record review the licensee did not comply with the section cited above as R1 was recently hospitalized on 08/26/2025 and no incident report was submitted to CCLD which poses a potential health, safety, or personal rights risk to clients in care.
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Type B
09/18/2025
Section Cited
CCR87458(a)

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87458 Medical Assessment
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment... made within the last year, to be kept in the resident's record.
This requirement is not met as evidenced by:
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Facility Designee agreed to obtain a completed medical assessment for R2 and to submit the document to CCLD no later than POC due date.
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Based on interview and record review the licensee did not comply with the section cited above as R2's file did not contain a completed medical assessment which poses a potential health risk to clients in care.
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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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/04/2025 01:01 PM - It Cannot Be Edited


Created By: Trevor Byrne On 09/04/2025 at 12:09 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: VALLEY'S BEST HOMECARE
FACILITY NUMBER: 195850497

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2025
Section Cited
CCR
87609(b)(4)(C)

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(b) ..medical care may be provided... through a licensed home health agency...
(4) ...licensee and home health...agree in writing...
(C)The written agreement shall be... in the resident’s file.
This requirement is not met as evidenced by:
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Designee obtained consent from the family of R1 at the time of the visit to obtain R1's home health paperwork.
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Based on interview and record review the licensee did not comply with the section cited above as R1's file did not contain documentation of the written agreement between the licensee and Home Health which poses a potential health or personal rights risk to clients in care.
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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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2025


LIC809 (FAS) - (06/04)
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