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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850612
Report Date: 02/03/2026
Date Signed: 02/03/2026 05:12:41 PM

Document Has Been Signed on 02/03/2026 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:LAUREL CANYON RESIDENTIAL CAREFACILITY NUMBER:
195850612
ADMINISTRATOR/
DIRECTOR:		HARUTYUNYAN, KRISTINEFACILITY TYPE:
740
ADDRESS:8054 LAUREL CANYON BLVDTELEPHONE:
(747) 474-9514
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 6CENSUS: 2DATE:
02/03/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:06 PM
MET WITH:Mariam HarutyunyanTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 03:06 PM to conduct an unannounced Case Management – Deficiencies visit at the facility today. LPA met with facility Administrator Assistant Mariam Harutyunyan entrance interview conducted and the reason for the visit was explained. Administrator Kristine Harutyunyan later arrived to the facility and an entrance interview was conducted.

During today’s visit between 03:10 PM and 04:23 PM LPA conducted a physical plant tour, interviewed Administrator, the Assistant Administrator, and one (1) Individual (I1).

During the physical plant tour LPA observed bedroom #1’s ceiling to be in disrepair with visible water damage. LPA observed the ceiling to be missing a panel with insulation exposed. Additionally, LPA observed the room to smell of mildew. LPA reviewed the facility sketch and observed bedroom #1 to be designated as a staff bedroom. LPA interviewed the Assistant Administrator who informed LPA that residents had not resided in the room and staff had been relocated to bedroom #2 until repairs to bedroom #1 could be made. Assistant Administrator stated that the room has been made inaccessible to clients in care until repairs to the ceiling repair can be completed. Assistant Administrator stated that repairs are expected to be completed no later than 02/13/2026. LPA determined that the damage to the ceiling did not pose an immediate or potential health, safety, or personal rights risk to the clients in care. This is considered a technical violation and no citation is being issued at this time.

Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2026
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: LAUREL CANYON RESIDENTIAL CARE
FACILITY NUMBER: 195850612
VISIT DATE: 02/03/2026
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During interviews with the Assistant Administrator and during file review LPA observed that no incident report was submitted for the ceiling damage. Additionally, LPA observed the conversion of the facility’s garage into an ADU which was also not reported to Community Care Licensing Division (CCLD). LPA informed the Assistant Administrator that any incident which threatens the welfare, safety or health of any resident, or unexplained absence of any resident from the facility must be reported to CCLD within 7 days of the occurrence of the event. Additionally, LPA informed the Assistant Administrator that any construction or alterations to the facility should be reported to CCLD prior to beginning the proposed construction. Because no residents resided in bedroom #1 and because all proper building permits for the garage conversion appeared to be obtained LPA determined that the missing reports did not pose an immediate or potential health, safety, or personal rights risk to the clients in care. This is considered a technical violation and no citation is being issued at this time.

LPA spoke with the Administrator, Assistant Administrator, and I1 and informed them that due to the garage conversion to an ADU, the former garage now has a separate address from the facility. LPA explained that the facility is required to submit an updated facility sketch which reflects that the garage is no longer part of the facility as a part of their plan of operation. The Assistant Administrator expressed understanding and agreed to submit an updated facility sketch to CCLD. Additionally, LPA informed the Administrator that the fire clearance for the facility states “Garage to remain a garage”. LPA explained that because proper permits were obtained for the conversion no fire clearance violation is being issued at this time. LPA explained that the facility may be required to obtain an updated fire clearance at a later time to reflect the construction changes and new address of the former garage.

Pursuant to Title 22, California Code of Regulations, the following deficiency was cited (refer to LIC809-D). Exit interview conducted and copy of the report was issued and appeal rights were provided.

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

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/03/2026 05:12 PM - It Cannot Be Edited


Created By: Trevor Byrne On 02/03/2026 at 04:57 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: LAUREL CANYON RESIDENTIAL CARE
FACILITY NUMBER: 195850612

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/17/2026
Section Cited
CCR
87208(a)(7)

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87208 Plan of Operation
(a)…shall be submitted to the licensing agency for approval…shall contain...:
(7) Sketches, showing dimensions, of the following:
This requirement is not met as evidenced by:
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Administrator agreed to submit an updated facility sketch 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 licensee did not submit an updated facility sketch to the department after the conversion of the facility's garage to an ADU which poses a potential 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: 02/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2026


LIC809 (FAS) - (06/04)
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