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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850508
Report Date: 01/09/2025
Date Signed: 01/09/2025 12:56:34 PM

Document Has Been Signed on 01/09/2025 12:56 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:EM SENIOR LIVINGFACILITY NUMBER:
195850508
ADMINISTRATOR/
DIRECTOR:		SARKISIAN, LOUSINEFACILITY TYPE:
740
ADDRESS:13937 CANTLAY STREETTELEPHONE:
(747) 306-2317
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 1DATE:
01/09/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Kevin Parker, StaffTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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Licensing Program Analyst, Christine Yee, conducted an announced case management visit to ensure that the deficiencies noted on the initial Prelicensing and Component III visit on 11//7/2024 have been addressed on today's visit. LPA Yee met with Kevin Parker, Staff, Edmond Mkrtchyan, Designated Applicant, Ofelya Mkrtchyan, Staff and Elfrida Gevorkian, Staff. Lousine Sarkisian, Designated Administrator did not participate in today's visit.

The following was observed on today's visit:
  • 2 sets of bed linens consisting of a flat sheet, fitted sheet and a pillow case, 2 sets of mattress covers, 8 twin blankets were observed.
  • 2 sets of towels consisting of bath towels, hand towels and face towels were observed. Extra sets of towels were purchased during today's visit
  • Bedroom #1, located in the front of the home was observed with 2 captain style twin beds, 2 folding chairs, 2 lamps, a single multi-drawer shelf for night stands and a built in closet.
  • Personal items, bed linens and towels were removed from Bedroom #1's closet
  • Grab bars were observed in the common bathroom and a toilet safety rail for the toilet.
  • Bedroom #2 was observed with 2 twin beds, 2 folding chairs, 2 night stands, 2 lamps and a built in closet.
  • Extra Linens and blankets stored in the closet of Bedroom #3 were relocated and contains linens just for the residents who occupy the room. The windows were observed with curtains. The room was also observed with 2 lamps. The shelf used for the resident's television was moved against the bed so it is not blocking the back entrance.
  • The fire place was observed sealed up with plywood and covered with a painting.
  • Little flashlights were purchased for the residents and 4 staff.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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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: EM SENIOR LIVING
FACILITY NUMBER: 195850508
VISIT DATE: 01/09/2025
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  • The window screen was observed repaired in bedroom #1.
  • staff and resident files will be created and should contain all the required Title 22 documents
  • General liability insurance will purchased when the facility is licensed.


As of today's visit, the deficiencies observed on the initial Prelicensing and Component III has been corrected.

Exit interview was conducted with Ofelya Mkrtchyan, Kevin Parker, Edmond Mkrtchyan and Elfrida Gevorkian.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC809 (FAS) - (06/04)
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