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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850549
Report Date: 07/11/2025
Date Signed: 07/11/2025 05:12:53 PM

Document Has Been Signed on 07/11/2025 05:12 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 PARADISE BOARDING CAREFACILITY NUMBER:
195850549
ADMINISTRATOR/
DIRECTOR:		NIKOYAN, NAIRAFACILITY TYPE:
740
ADDRESS:12200 HATTERAS STTELEPHONE:
(818) 853-7278
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY: 6CENSUS: 4DATE:
07/11/2025
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:04 AM
MET WITH:Naira Nikoyan - LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a post-licensing visit at 10:04AM. The LPA met with the Licensee Naira Nikoyan and explained the reason for the visit. Entrance interview conducted.

Beginning at 10:12AM, the LPA and the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

COMMON AREAS: At the time of the visit, two (2) living rooms were observed with furniture in good condition. The facility’s entryway had an extra supply of linens and supplies. Required postings were observed in the first living room. LPA observed an unoccupied bed in the first living room and the Licensee understood it needed to be removed. The second living room had an office area with a locked cabinet that stored extra medications. LPA observed Resident #1 (R1) residing in the second living room who was also observed at 12:03PM to be Bedridden. The Licensee stated R1 was admitted two (2) days ago and Hospice had placed them there. The LPA notified the Licensee that R1 will need to be relocated to the approved Bedridden bedroom by the end of today, 07/11/2025. Emergency food and water were stored in a hallway pantry. The facility maintained a comfortable temperature throughout the visit. Smoke and carbon monoxide detectors were tested at 10:52AM and were operational at the time of the visit.

Report Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2025
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 07/11/2025 05:12 PM - It Cannot Be Edited


Created By: Quoc Huynh On 07/11/2025 at 03:49 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 PARADISE BOARDING CARE
FACILITY NUMBER: 195850549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)
87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Saefty Code Section 159.17(b) shall prior to working, residing, or volunterring in a licensed facility
: ...
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 2 Staff did not obtain a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2025
Plan of Correction
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The Licensee will have the 2 Staff obtain their criminal record clearance and send proof of clearance to CCLD. The 2 Staff will not be allowed on the facility's property until they are cleared.
Type A
Section Cited
CCR
87202(a)
87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or ... fire department ...

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 1 resident was Bedridden and resided in the second living room, which is not approved, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2025
Plan of Correction
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The Licensee will relocate the resident to Bedroom #1, which is approved for 1 bedridden resident. The Licensee will send CCLD proof by 8PM on 07/11/2025.
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:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/11/2025 05:12 PM - It Cannot Be Edited


Created By: Quoc Huynh On 07/11/2025 at 04:01 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 PARADISE BOARDING CARE
FACILITY NUMBER: 195850549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfenctants, cleaning soluation, poisonous substances, knives, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in steak knives, bug repellent, and one shed containing tools were not locked which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2025
Plan of Correction
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The Licensee secured the steak knives, bug repellent, and the outside shed. POC Cleared.
Type A
Section Cited
CCR
87465(h)(2)
87465 Incidental Medical and Dental Care Services (h) The following requirements shall apply to medications ... (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in refridgerated medications were not locked and 1 resident was allowed to store their medications they were not allowed access to which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/11/2025
Plan of Correction
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The Licensee secured the refrigerated medications. The Licensee obtained and centrally stored the medications the resident had access to. POC Cleared.
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:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2025


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: VALLEY PARADISE BOARDING CARE
FACILITY NUMBER: 195850549
VISIT DATE: 07/11/2025
NARRATIVE
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KITCHEN: Knives and Medications were stored inaccessible in a locked cabinet. However, LPA observed accessible steak knives in a cabinet across from the refrigerator. Additionally, the Medication fridge near the same cabinet was not secured. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food. LPA observed operating laundry machines in a kitchen closet that also stored extra facility supplies.

BEDROOMS/RESTROOMS: There were three (3) total bedrooms with dual occupancy. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom #1 was approved for one (1) Bedridden resident and had a direct exit to the outside. Bedroom #3 had a direct exit to the outside and LPA observed Resident #2 (R2) had access to their Insulin Pen Needles and had a needle disposal bin on their bedside. After reviewing Physician’s Reports, R2 and Resident #3 (R3) residing in Bedroom #3 were not allowed access to store their own medications and pose a safety risk. The Licensee stated that R2 did not want assistance with their Insulin, and the Licensee allowed R2 to have possession of it. There were three (3) total restrooms in the facility: one (1) private restroom attached to Bedroom #1, one (1) guest restroom in the hallway, and one (1) shared resident restroom in the hallway. The restrooms were clean and sanitary. Hot water was tested and measured between 118 degrees F and 118.9 degrees F, which is within the required range.

OUTDOOR AREA: The outdoor area consisted of the front yard and rear patio. The LPA observed two (2) aerosol bug repellent sprays on the patio furniture. The front yard had two (2) driveway gates that were remote and manually operated, with an additional gate entrance for everyday use. LPA observed an accessible Additional Dwelling Unit (ADU) in the rear which was occupied by the Licensee and their family. The side of the ADU had two (2) sheds: one (1) contained various tools and was unlocked, and one (1) shed contained general storage that was locked. No bodies of water noted, and exits are free of obstructions.

Report Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
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 PARADISE BOARDING CARE
FACILITY NUMBER: 195850549
VISIT DATE: 07/11/2025
NARRATIVE
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MEDICATIONS: Medication review began at 10:57AM. Medications were centrally stored and kept inaccessible in the kitchen and office area. Medications were observed for two (2) residents. No immediate concerns were observed.

RECORDS: Record review began at 12:13PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. Residents’ documentations were not complete at this time. LPA was unable to review Personnel records due to the facility not completing them upon the Staff’s employment. Additionally, two (2) Staff did not obtain their fingerprint clearance per regulation. One (1) Staff requested clearance but was not cleared due to an incomplete application.

Due to time constraints, the LPA will return at a later date to conduct a continuation visit.

Pursuant to Title 22 of the CA Code of Regulations and/or Health and Safety Code, the following deficiencies were cited. (Refer to LIC 809-D).

An immediate civil penalty of $500 for a violation of the facility’s fire clearance was issued (Refer to LIC 412M). The Licensee understands that continued violation of the facility’s fire clearance may result in additional civil penalties.

An immediate civil penalty of $100 per day for a maximum of 5 days in the amount of $1,000 for employment without a criminal record clearance and/or exemption was issued for two (2) Staff (Refer to LIC 421BG). The Licensee understands that continued employment without a criminal record clearance and/or exemption may result in additional civil penalties.

Exit interview conducted. A copy of the Appeal Rights and today’s report was reviewed and provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC809 (FAS) - (06/04)
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