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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850586
Report Date: 03/04/2025
Date Signed: 03/04/2025 07:27:18 PM

Document Has Been Signed on 03/04/2025 07:27 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:ALL STAR LIVING INCFACILITY NUMBER:
195850586
ADMINISTRATOR/
DIRECTOR:		SOGHOMONYAN,LALAFACILITY TYPE:
740
ADDRESS:8123 PASO ROBLES AVETELEPHONE:
(818) 802-0866
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 6CENSUS: 2DATE:
03/04/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Satenik AlajanyanTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility announced to conduct a pre-licensing inspection. The LPA met with Applicant Satenik Alajanyan. This is a Residential Care Facility for the Elderly (RCFE) application for a Change of Ownership (CHOW) from Prime Senior Living F# 195850263 to All Star Living Inc. F#195850586. The current capacity is for six (6) elderly ambulatory residents, the facility currently has two (2) residents. The fire clearance was granted on 12/11/2024 for Ambulatory residents Only. The ADU observed in the back of the property was not included in this Fire clearance.

The LPA and the applicant 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.

COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. The common areas, walls, flooring and furniture were checked for cleanliness and were found to be in good condition. Some of the required postings were observed on a board on the wall next to the kitchen area; however, the following postings are missing Residents Rights (LIC 613), and the Emergency Disaster Plan (LIC610E) will need to be updated to reflect staff responsibilities in case of an emergency. Emergency exiting plans/sketch are posted on the same board.

KITCHEN: Kitchen knives are stored locked, and inaccessible to residents in a kitchen cabinet. The supply of perishable, and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean, and all appeared functional. There is an adequate supply of emergency food. The fire extinguisher is mounted on the wall by the kitchen area; however, the fire extinguisher did not have a receipt of purchase, the applicant explained that it was purchased in 2024, however, the date of the purchase could not be determined. The applicant will look for receipt or may purchase a new fire extinguisher. LAUNDRY: Washer and dryer are located in the kitchen area.


Continues on LIC 809C...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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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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: ALL STAR LIVING INC
FACILITY NUMBER: 195850586
VISIT DATE: 03/04/2025
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BEDROOMS: The facility has (4) bedrooms, all bedrooms are resident bedrooms. No staff bedroom was available. Bedrooms #1 and #4 are single occupancy, bedrooms #2 and bedroom #3 are shared rooms. Bedroom #4 needs a closet installed for resident’s clothes. All residents’ bedrooms are furnished appropriately with clean linens, furnishings, and sufficient lighting.
BATHROOMS: There are two (2) full bathrooms. One is a private bathroom in bedroom #1, and the second bathroom is located in the hallway. The private’s bathroom wall has a dent on the wall which needs to be repaired. The shower is equipped with nonskid mats. Grab bars were observed in the bathroom. The hot water temperature in the bathroom measured 130.1 degrees Fahrenheit.
MEDICATIONS: Medications are stored in kitchen cabinet that was observed to be locked during the visit and was observed to be locked and inaccessible to residents in care. The first aid supplies were complete, including a first aid manual, and is located inside a cabinet by the kitchen area.
FILES: Resident and staff records are stored in a file cabinet located in a corner of the common area between the dining room and the living room area.

EXTERIOR: The exterior passageways were clean, and clear of any obstructions. There is a covered patio area on the side yard with a sitting area for residents’ use. On the left-hand side of the house, there are two open areas on the ground that will need to be covered to prevent residents from falling in.
ADU: An additional dwelling unit was observed in the rear of the property, which can be accessed by residents and staff. The ADU was vacant at the time of the visit. Per the applicant they plan to submit an application for another facility license for this ADU. The applicant stated that it would be under the name of the current applicant. The LPA advised the applicant that no other people (not affiliated the facility/and/or background cleared) can live in the ADU.

Continues on LIC 809C...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
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: ALL STAR LIVING INC
FACILITY NUMBER: 195850586
VISIT DATE: 03/04/2025
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Pre-Licensing is incomplete with deficiencies to be resolved by 3/21/2025. Follow up Pre-licensure LIC809 will be generated upon resolution.

· The following postings are missing Residents Rights (LIC 613), and the Emergency Disaster Plan (LIC610E) will need to be updated to reflect staff responsibilities in case of an emergency.

· The fire extinguisher is mounted on the wall by the kitchen area; however, the fire extinguisher did not have a receipt of purchase.

· Bedroom #4 needs a closet installed for resident’s clothes.

· The private’s bathroom wall has a dent/hole on the wall which needs to be repaired.

· The hot water temperature in the bathroom measured 130.1 degrees Fahrenheit.


· On the left-hand side of the house, there are two open areas on the ground that will need to be covered to prevent residents from falling in.

Applicant completed Component III at 02:05 p.m.

This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license.

Exit interview conducted with applicant, and the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
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