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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850570
Report Date: 02/25/2026
Date Signed: 02/25/2026 05:17:55 PM

Document Has Been Signed on 02/25/2026 05:17 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:WISDOM WILLOW SENIOR LIVINGFACILITY NUMBER:
195850570
ADMINISTRATOR/
DIRECTOR:		SARKISIAN, LOUSINEFACILITY TYPE:
740
ADDRESS:7342 BECK AVENUETELEPHONE:
(818) 255-6295
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 6CENSUS: 5DATE:
02/25/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:28 AM
MET WITH:Lousine SarkisianTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Trevor Byrne conducted a case management - deficiencies visit at the facility today. LPA arrived to the facility at 10:15 AM. LPA met with facility staff who contacted the Administrator Lousine Sarkisian via telephone call. The Administrator arrived to the facility at 10:27 AM. Entrance interview conducted and the reason for the visit was explained.

During today’s visit, the LPA conducted a brief physical plant tour, collected copies of documentation, and conducted interviews with two (2) residents, the Administrator, and one (1) staff between approximately 10:28 AM and 04:30 PM.

During the physical plant tour LPA observed a shed located on the side of the house. The shed was observed be unlocked with a key placed into the lock left unattended. LPA observed this shed to contain various cleaning chemicals. LPA informed the Administrator that disinfectants, cleaning solutions, poisonous substances, knives, matches, 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. The Administrator expressed understanding and secured the chemicals at the time of the visit.

LPA observed bedroom #3’s direct emergency exit to be blocked by a chair. Additionally LPA observed the facility’s front door to contain a deadbolt with a key lock on both sides of the door. LPA observed this deadbolt to be locked at the time of the inspection. LPA informed the Administrator that the facility does not have the appropriate fire clearance to lock doors leading to the exterior of the facility nor did the facility notify Community Care Licensing Division of their intent to lock exterior doors. LPA informed the Administrator that this constitutes a violation of the facility’s fire clearance and that this is a zero tolerance violation. LPA informed the Administrator that an immediate civil penalty in the amount of $500 is being assessed on today’s date (02/25/2026) for a violation of the facility’s fire clearance. Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2026
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: WISDOM WILLOW SENIOR LIVING
FACILITY NUMBER: 195850570
VISIT DATE: 02/25/2026
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The Administrator expressed understanding, removed the chair from bedroom #3’s exit door, and installed a standard deadbolt on the facility’s front door at the time of the visit.

During the physical plant tour LPA observed Staff #1 (S1) working at the facility providing care and supervision to the residents. LPA was informed by the Administrator that S1 had worked for the facility since 07/02/2025. LPA reviewed the list of individuals associated to the facility and did not observe S1 associated to the facility. LPA informed the Administrator that all individuals subject to a criminal record review shall obtain a criminal record clearance and be associated to the facility prior to working, residing or volunteering in a licensed facility. LPA informed the Administrator that not having S1 associated to the facility would result in the assessment of a Background Check Civil Penalty (BCCP) in the amount of $100/day per employee for a maximum of five (5) days for the first offense. LPA stated that a civil penalty in the amount of $500 is being assessed on today’s date (02/25/2026) for S1 not being associated to the facility. The Administrator expressed understanding and agreed to associate S1 to the facility.

During record review LPA observed an incident that occurred with Resident #1 (R1) on 02/20/2026. LPA interviewed the Administrator who stated that R1 arrived to the facility on 02/18/2026 and was discharged back to the hospital on 02/20/2026. The Administrator informed LPA that no preadmission appraisal of R1 was conducted and no physician’s report for R1 was obtained prior to R1 entering the facility. LPA informed the Administrator that prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs. Additionally, LPA stated that prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year. The Administrator expressed understanding and confirmed that they were aware of these requirements. The Administrator stated that R1 would not be returning to the facility but agreed to submit a statement of understanding confirming that they are aware of, and will complete, all required pre-admission documentation prior to accepting residents into the facility.

Pursuant to Title 22 California Code of Regulations the following deficiencies were cited and civil penalties were assessed. Exit interview conducted, report was reviewed, and a copy of the report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 02/25/2026 05:17 PM - It Cannot Be Edited


Created By: Trevor Byrne On 02/25/2026 at 03:32 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: WISDOM WILLOW SENIOR LIVING
FACILITY NUMBER: 195850570

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2026
Section Cited
HSC
1569.149

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§1569.149 Fire clearance...
... the facility shall secure and maintain a fire clearance...
This requirement is not met as evidenced by:
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Administrator swapped the double keyed deadbolt for a standard deadbolt at the time of the visit. Administrator removed the chair at the time of inspection. POC cleared.
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Based on observation the licensee did not comply with the section cited above as an emergency exit was blocked by a chair at the time and the facility had a front door that was locked via key/deadbolt from the inside of the facility which poses an immediate safety risk to persons in care.
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Type A
02/26/2026
Section Cited
CCR87309(a)

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87309 Storage Space and Access
(a)... the licensee shall ensure that disinfectants, cleaning solutions...and other similar items..are in locked storage and are not left unattended..
This requirement is not met as evidenced by:
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Administrator agreed to train staff on the importance of locking chemicals up and placing the key for the storage in a secure location where residents do not have access. Administrator agreed to submit proof of training to CCLD no later than POC due date.
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Based on observation the licensee did not comply with the section cited above as the outdoor storage closet was full of cleaning supplies was left unlocked and unattended with the key left in the lock which poses an immediate safety risk to persons 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: 02/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/25/2026 05:17 PM - It Cannot Be Edited


Created By: Trevor Byrne On 02/25/2026 at 03:41 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: WISDOM WILLOW SENIOR LIVING
FACILITY NUMBER: 195850570

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/11/2026
Section Cited
CCR
87355(b)

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87355 Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:
This requirement is not met as evidenced by:
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Administrator agreed to associate S1 to the facility and to send proof of association to CCLD no later than POC due date.
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Based on record review the licensee did not comply with the section cited above as S1 had finger print clearance but was not associated to the facility which poses a potential safety or personal rights risk to persons in care.
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Type B
03/11/2026
Section Cited
CCR87457(c)(1)

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87457 Pre-Admission Appraisal
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed...
(1) The appraisal shall document, at a minimum:
This requirement is not met as evidenced by:
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The Administrator agreed to submit a statement of understanding confirming that they are aware of, and will complete, all required pre-admission documentation prior to accepting residents into the facility. Administrator agreed to sign this statement along with the Owner of the
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Based on record review the licensee did not comply with the section cited above as R1 did not have a pre-admission appraisal completed prior to their acceptance as a resident to the facility which poses a potential safety or personal rights risk to persons in care.
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facility and to submit this statement to
CCLD no later than POC due date.
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: 02/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/25/2026 05:17 PM - It Cannot Be Edited


Created By: Trevor Byrne On 02/25/2026 at 03:47 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: WISDOM WILLOW SENIOR LIVING
FACILITY NUMBER: 195850570

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/11/2026
Section Cited
CCR
87458(a)

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87458 Medical Assessment
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment...
This requirement is not met as evidenced by:
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The Administrator agreed to submit a statement of understanding confirming that they are aware of, and will complete, all required pre-admission documentation prior to accepting residents into the facility. Administrator agreed to sign this statement along with the Owner of the
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Based on record review the licensee did not comply with the section cited above as R1 did not have a medical assessment completed prior to their acceptance as a resident to the facility which poses a potential safety or personal rights risk to persons in care.
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facility and to submit this statement to
CCLD no later than POC due date.

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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: 02/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2026


LIC809 (FAS) - (06/04)
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