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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850542
Report Date: 04/21/2025
Date Signed: 04/21/2025 05:36:18 PM

Document Has Been Signed on 04/21/2025 05:36 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:ROSE GARDEN SENIOR HOUSINGFACILITY NUMBER:
195850542
ADMINISTRATOR/
DIRECTOR:		TONOYAN, LILITFACILITY TYPE:
740
ADDRESS:7526 TROOST AVENUETELEPHONE:
(818) 601-3232
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 6CENSUS: 3DATE:
04/21/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Lilit TonoyanTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 09:45 AM. LPA met with facility staff who contacted the facility Administrator Lilit Tonoyan. The Administrator arrived to the facility at approximately 10:15 AM the reason for the visit was explained and entrance interview was conducted.

During today’s visit LPA conducted a physical plant tour, reviewed three (3) resident files, three (3) staff files, conducted a medication audit for two (2) residents, and interviewed the Administrator, the Licensee, one (1) staff and two (2) residents between 10:00 AM and 02:30 PM.

Interviews with the facility Administrator and resident #1 (R1) revealed that the facility did not have a dedicated internet access device for resident use. Interviews with R1 revealed that in April R1 was unable to attend an in-person appointment with their primary care physician. R1’s physician requested that the appointment be done via Zoom or Face-Time call. R1 revealed that the facility did not provide a device that was capable of video conferencing, so the appointment was conducted over the telephone instead. In the interview with the Administrator they stated that the internet access device for the facility is the Administrator’s personal cell phone. LPA informed the Administrator that the device must always be present at the facility and must be dedicated for resident use. The Administrator agreed to obtain an internet access device to be left at the facility for resident use.

Interviews with R1, Witness #1 (W1), and Staff #1 (S1) revealed that the facility has been crushing medications into R1's food. W1 stated that the facility informed them that they had crushed medications into R1's food. An interview with S1 confirmed that the facility has crushed medications and disguised it into R1's foods. The facility Administrator admitted that staff crush medications into R1's foods.

The following deficiency was cited (Refer to LIC 809D). Exit interview conducted, appeal rights and a copy of the report were provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2025
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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Document Has Been Signed on 04/21/2025 05:36 PM - It Cannot Be Edited


Created By: Trevor Byrne On 04/21/2025 at 03:58 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: ROSE GARDEN SENIOR HOUSING
FACILITY NUMBER: 195850542

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2025
Section Cited
HSC
1569.319(a)

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§1569.319
(a) A licensee...shall provide at least one internet access device...that can support ... videoconferencing technology, including microphone and camera functions, and is dedicated for resident use.
This requirement is not met as evidenced by:
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Licensee will submit proof of an appropriate internet access device to stay at the facility and be for resident use. Licensee will submit proof no later than POC due date.
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Based on observation and interview the licensee did not comply with the section cited above as the facility did not have a resident dedicated internet access device which poses a potential health or personal rights risk to clients in care.
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Type B
05/05/2025
Section Cited
CCR87465(a)(5)(D)

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87465Incidental Medical and Dental care
(a) ...compliance with the following:
(5) ... shall be limited to the following:
(D Assistance with self-administration does not include...hiding or camouflaging medications in other substances...
This requirement is not met as evidenced by:
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Licensee will submit a statement of understanding confirming that they will not disguise or crush medications of residents. Licensee will submit this statement to CCLD no later than POC due date.
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Based on interview the licensee did not comply with the section cited above as the facility has been crushing R1's medications into their food which poses a potential 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: 04/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2025


LIC809 (FAS) - (06/04)
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