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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850563
Report Date: 07/02/2025
Date Signed: 07/02/2025 05:27:19 PM

Document Has Been Signed on 07/02/2025 05:27 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:7 HEAVENFACILITY NUMBER:
195850563
ADMINISTRATOR/
DIRECTOR:		NSHANIAN, HERMINEFACILITY TYPE:
740
ADDRESS:6215 BLUEBELL AVENUETELEPHONE:
(818) 732-7378
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 0DATE:
07/02/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Kristine Abasyan, ApplicantTIME VISIT/
INSPECTION COMPLETED:
05:35 PM
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Licensing Program Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit to ensure that the home met Title 22 requirements. LPA Yee met with Kristine Abasyan, Designated Applicant and Ripa Tavitian, facility's Consultant, who was assisting with today's visit. Hermine Nshanian, Designated Administrator was not feeling well and was not able to join in today's visit.

The home is a single storey family home consisting of a living room, dining room, a kitchen, 4 resident bedrooms, 3 bathrooms and a attached garage. The home is fire cleared for 5 non-ambulatory and 1 bedridden resident. Bedroom #4 is the room designated for bedridden use.

On today's visit all domain's of the CARE Inspection Tool were reviewed except for the Physical Plant and Environmental Safety domain. The Plan of Operations, Infection Control and Emergency Disaster Preparedness Plan were reviewed. A return visit will have to be scheduled to complete the last domain and to conduct the Component III visit.

The following was observed on today's visit:
  • The living room was furnished with 2 sofas, 2 love seat, arm chair, a metal filing cabinet for centrally stored medications and a smaller filing cabinet for other use. Also located in the living room was a desk with a monitor and a printer and a television. The blinds on the living room window are warped and the blinds on the sliding glass door are missing slates. Cobwebs were observed on the ceiling and in the corners were cleaned during the visit.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2025
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: 7 HEAVEN
FACILITY NUMBER: 195850563
VISIT DATE: 07/02/2025
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  • A fire extinguisher purchased on 9/24/24 was mounted in the living room and one in the attached garage.
  • The dining room was furnished with a table and 6 chairs.
  • Bedroom #1 was toured and observed with 1 hospital bed with full bed rails,a night stand, a lamp, a chair, a chest of drawers that don't meet the 8 cubic feet requirement and a built in closet. The front corner of the left wall was scratched and needs to be painted. The slate on the top of the window blinds need to be secured. The bed was observed with a mattress cover, a fitted sheet and a throw blanket. Observed in the closet were 10 pillow cases, 5 fitted sheets and 4 bath towels. No flat sheets, twin blankets, comforter, hand towels or face towels were observed.
  • Located inside Bedroom #1 is a private bathroom equipped with a shower stall, a shower chair, a grab bar, a slip resistant mat and a toilet riser handle. The water was tested and read 105.6 degrees Fahrenheit.
  • The first aid kit was reviewed and contained the required supplies, including a pair of scissors, a tweezer and a thermometer
  • There were no files created for the residents and staff under the new ownership.
  • The facility has internet and a tablet for resident's use was observed.

The facility tour was ended due to many deficiencies noted. Additional inspection is needed for Bedroom #2 and a complete inspection is needed for Bedroom #3 and Bedroom #4. Outside areas also need to be toured.

As of today's visit the following deficiencies were observed and need to be addressed:
  • the facility sketch needs to be updated to reflect the assembly point
  • all full bed rails need to be removed, unless the residents are on hospice and the care plan addresses the use of full bed rails.
  • the Emergency Preparedness Plan needs to be updated to provide plan details instead of general statements
  • The rights of Family council and a current 2025 Labor poster needs to be posted.
  • The Admission Agreement needs to be updated to include the facility's policy on firearms.
  • Bedroom #2, designated for double occupancy was observed with a single bed with full bed rails. Additional beds need to be purchased for a total of 6 residents.
  • The visiting hours need to be posted

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NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
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: 7 HEAVEN
FACILITY NUMBER: 195850563
VISIT DATE: 07/02/2025
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A subsequent visit is needed to complete the Prelicensing and Component III visit. Corrections of the deficiencies observed today will be reviewed on the return visit. Anything that is not addressed on today's visit will be addressed on the return visit.

Exit interview was conducted.
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NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC809 (FAS) - (06/04)
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