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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850532
Report Date: 05/30/2025
Date Signed: 05/30/2025 08:42:40 PM

Document Has Been Signed on 05/30/2025 08:42 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:C&C SENIOR LIVING INCFACILITY NUMBER:
195850532
ADMINISTRATOR/
DIRECTOR:		HESHMATI, CLAUDIAFACILITY TYPE:
740
ADDRESS:6623 VESPER AVETELEPHONE:
(818) 913-2472
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 3DATE:
05/30/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Claudia HeshmatiTIME VISIT/
INSPECTION COMPLETED:
08:50 PM
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Licensing Program Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit to ensure that the home is in compliance with Title 22. The CARE Inspection Tool was utilized. LPA Yee met with Claudia Heshmati, Designated Applicant and Kevin Kalantar Ohanian, Corporate Officer.

The facility is a single storey family home consisting of a living room, a dining room, a kitchen, 4 resident bedrooms and 2 full bathrooms. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #4 is the bedroom designated for bedridden use.

The following was observed on today's visit:
The following were observed on today's visit:
  • The living room and dining room are furnished with the appropriate furnishing and seating for 6 residents.
  • The kitchen has a stove, dishwasher and refrigerator. Sufficient plates, cups, utensils for 6 residents were observed. Pots, pans, storage containers were observed. Perishable foods for a minimum of 2 days will be purchased prior to accepting the first resident and sufficient non-perishable for a minimum of 7 days was observed maintained on the premises.
  • Located in the kitchen is the only fire extinguisher that was purchased on 7/2/24.
  • Employment Poster was posted in the dining room and the required posting were observed in the living room.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2025
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: C&C SENIOR LIVING INC
FACILITY NUMBER: 195850532
VISIT DATE: 05/30/2025
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  • Bedroom #1, directly by the front door, was observed with 2 hospital bed, 2 night stands, 2 lamps, 2 folding chairs, 2 dressers, television and 2 closets. The required bed linens were observed on the beds.
  • Bedroom #2 is a private room and contains 1 bed, 1 folding chair, 1 night stand, 1 lamp, a television and a dresser. Also located in the room is the resident's personal massage chair
  • Bedroom #3 is a shared room and was observed with 2 beds, 2 chairs, 2 night stands, 2 lamps, 2 dressers, a television and a shared closet. Located inside the room is a private bathroom equipped with a tub with shower, a toilet and 2 sink vanity. Grab bars were observed in the shower and behind the toilet. Slip resistant map was observed. Water temperature was tested and read 112.8 degrees Fahrenheit.
  • Bedroom #4 is a private room with a hospital bed with half bed rails, a night stand, a lamp, a chair, dresser, television and a closet. A door in the room leads directly to a ramp located outside. The window blind on the right window was broken.
  • The common bathroom is equipped with a shower stall, a bath tub, a toilet, and a single sink. Grab bars were observed in the shower and behind a toilet. A grab needs to be installed for the bath tub. The water temperature was tested and read 113.4 degrees Fahrenheit.
  • The laundry room was observed with a washer and dryer. Cleaning solutions, laundry detergent, hygiene products were stored on a shelf in the room. Per the Applicant, the room is always locked.
  • The auditory device on the outside exiting doors - front door, kitchen door and bedroom #4 were tested and were operational.
  • The backyard has a covered patio furnished with a coffee table, a rattan love seat, 2 arm chairs and a bench for activities. The creeping plant along the back wall needs to be trimmed and the weeds need to be removed from the back yard.
  • The front yard was clean. 2 rattan chairs and a coffee table were observed in the front patio. Trash cans in the front yard were observed to be tightly sealed.
  • A first aid kit and first aid manual was observed.
  • The only carbon monoxide located above the door of bedroom #4 was tested and was operational.
  • The hard wired smoke alarms located in the 3 resident rooms and the hallway was tested and
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
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: C&C SENIOR LIVING INC
FACILITY NUMBER: 195850532
VISIT DATE: 05/30/2025
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  • was operational.
  • The facility has a land line phone. The telephone # is (818)387-8161.

The following corrections need to be completed prior to licensure:
  • the right side blinds in bedroom #4 needs to be replaced.
  • the vines on the back wall needs to be trimmed and the weeds removed.
  • a grab bar and a slip resistant mat needs to be placed for the bath tub.
  • the LIC610 - Emergency and Disaster Plan needs to be completed to include all emergency telephone numbers.
  • The facility will update their Admission Agreement to include their policy on the prohibition or the retention of firearms.
  • The Emergency Disaster Preparedness Plan needs to be revised to include additional information on the planned sheltering in place procedures, being self reliant for a period of 72 hours, transportation needs, communication needs, provisions for emergency power, operating of assistive medical devices, assisting residents with self administration of medications.


The following needs to be completed upon licensure:
  • create new resident, staff and volunteer files under the new license and name
  • purchase liability insurance with limits of a $1 million per occurrence and a total annual aggregate of $3 million.

Component III was conducted with Claudia Heshmati, Applicant and Kevin K Ohanian, Corporate Officer.
Applicant will notify LPA Yee once the corrections have been completed

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: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC809 (FAS) - (06/04)
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