195850645-11-17-2025-29-AS-ZCHN-DNHVM2-20251117153249

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850645
Report Date: 11/17/2025
Date Signed: 11/17/2025 03:35:10 PM

Document Has Been Signed on 11/17/2025 03:35 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CARED WITH LOVE		FACILITY NUMBER:	195850645
ADMINISTRATOR/ DIRECTOR:	HOVHANNISYAN,KIM		FACILITY TYPE:	740
ADDRESS:	19829 WELLS DR		TELEPHONE:	(818) 370-2077
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY: 6		CENSUS: 0	DATE:	11/17/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:15 PM
MET WITH:	Kim Hovhannisyan		TIME VISIT/ INSPECTION COMPLETED:	03:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Zabel Chochian conducted an announced Pre-Licensing visit to the above facility and met with Applicant/Licensee, Kim Hovannisyan. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Fire Clearance was approved on 07/017/2025 for a maximum capacity of six (6) non-ambulatory residents, of which one (1) bedridden residents. Hospice waiver approved for six (6) residents. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: BEDROOMS: There are five (5) bedrooms designated for clients use. All bedrooms are furnished with beds, dressers, chair and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. Hallway night lights observed operable. BATHROOMS: There are two bathrooms, one in resident room #2 and one common bathroom for guest and residents use. LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bars and non-skid mats for the shower. Hot water temperature was measured at 116.5 degrees Fahrenheit. COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The living room and dining area. KITCHEN: The facility Kitchen was toured and observed with operable appliances. Adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6) resident and staff observed. All knives and sharps are to be locked in a kitchen cabinet and inaccessible to residents. Fire Extinguisher was last purchased on 09/2025. appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. MEDICATIONS: The medication and facility staff/resident files will be kept in a locked cabinet located kitchen cabinet. (Continue to LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CARED WITH LOVE	FACILITY NUMBER: 195850645
	VISIT DATE: 11/17/2025

NARRATIVE

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SMOKE DETECTORS/CARBON MONOXIDE. Dual smoke and carbon monoxide detectors were located throughout the facility. Smoke detectors observed in each resident room. Detectors were tested and observed to be operational. GARAGE: The washer/dryer observed in the garage; appeared to be in good condition. Laundry supplies are kept inaccessible when not in use. SURROUNDING GROUNDS: LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The backyard is fenced. There is a unit in the back that might be separated with a different address in the future for a new facility. Applicants acknowledged understanding that the back unit may only be used as a recreational room at this time per fire clearance. The exterior passageways were clean and clear of any obstructions. There are no bodies of water on the premises at the time of the visit. Self-latching gate located at the side of the facility. Physical plant is consistent with the submitted facility sketch/floor plan.

During today’s visit, LPAs reviewed facility’s program plan, personnel policies, abuse reporting procedures, in-service training protocol, and medication procedures. The physical plant of this facility location is in compliance with Title 22 regulations at this time.

Component III Orientation was conducted in conjunction with the visit at 2:30 P.M.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview was conducted and with a copy of this report was provided to the Applicant/Administrator.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025

LIC809 (FAS) - (06/04)

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