<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850532
Report Date: 08/06/2025
Date Signed: 08/06/2025 04:37:46 PM

Document Has Been Signed on 08/06/2025 04:37 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: 5DATE:
08/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Kevin Ohanian, StaffTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit due to the deficiencies noted during a visit to the facility. LPA Yee met with Kevin Ohanian, Staff. The reason for today's visit was provided.

The following was observed during the visit:
  • residents who were residents of the previous ownership do not have new files, medical assessments or completed admissions agreement and Resident #1 and Resident #3, who were both admitted to facility in mid-July 2025 do not have any files.
  • Resident #3 was observed on a oxygen concentrator and a little tank of oxygen was stored in a corner by the foot of the hospital bed and no oxygen in use signs were observed in the facility. Also per Staff and the Administrator, the local fire department was not notified verbally or in writing
  • Per interview with staff, Resident #3 was hospitalized on the date they were admitted, and on and off since, and none of the hospitalization was reported to the Department within 7 days of the occurrence.


Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8.

Exit interview was conducted, Appeals 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: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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)
Page: 2 of 4
Document Has Been Signed on 08/06/2025 04:37 PM - It Cannot Be Edited


Created By: Christine Yee On 08/06/2025 at 03:31 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: C&C SENIOR LIVING INC
FACILITY NUMBER: 195850532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2025
Section Cited
CCR
87506(a)

1
2
3
4
5
6
7
Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee will ensure that files are created for all residents, staff and volunteer and maintained in the facility at all times. Licensee will create files for all residents and ensure that it contains all the required documents by 8/13/25. The Licensee will self certify that files have been completed and
8
9
10
11
12
13
14
Resident #2, #4,#5 do not have new files created due to the change in ownership and Resident #1 and Resident #3 do not have any files as of this visit.
8
9
10
11
12
13
14
contain all the documents required under Section 87506.
Type B
08/13/2025
Section Cited
CCR87618(b)(3)(A)

1
2
3
4
5
6
7
Oxygen Administration - Gas and Liquid: In addition to Section 87611(b), the licensee shall be responsible for the following: In addition to Section 87611(b), the licensee shall be responsible for the following:
Ensuring that the use of oxygen equipment meets the following requirements:
1
2
3
4
5
6
7
Licensee will ensure that all use of oxygen is reported to the local fire jurisdication. The LIcensee will draft a letter to the local fire jurisdication and send confirmation that the fire department was notified by 8/13/25.
8
9
10
11
12
13
14
A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. This requirement was not met as evidenced by: Resident #3 uses oxygen and the Licensee did not report its use to the local fire department as of this visit
8
9
10
11
12
13
14
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: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/06/2025 04:37 PM - It Cannot Be Edited


Created By: Christine Yee On 08/06/2025 at 03:57 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: C&C SENIOR LIVING INC
FACILITY NUMBER: 195850532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2025
Section Cited
CCR
87618(b)(3)(B)

1
2
3
4
5
6
7
Oxygen Administration - Gas and Liquid: In addition to Section 87611(b), the licensee shall be responsible for the following: In addition to Section 87611(b), the licensee shall be responsible for the following:
Ensuring that the use of oxygen equipment meets the following requirements:
1
2
3
4
5
6
7
The Licensee will create "No Smoking-Oxygen in Use" signs and post them in the appropriate areas by 8/13/25
Evidence that the signs have been posted will be sent the Department by 8/13/25
8
9
10
11
12
13
14
"No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas.
This requirement was not met as evidenced by: There were "No Smoking-Oxygen in Use" posted any where in the facility.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4