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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604780
Report Date: 12/18/2025
Date Signed: 12/19/2025 03:37:17 PM

Document Has Been Signed on 12/19/2025 03:37 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:VILLA MULHOLLAND IIFACILITY NUMBER:
197604780
ADMINISTRATOR/
DIRECTOR:		RIMMA GORDONFACILITY TYPE:
740
ADDRESS:4501 SAN FELICIANO DR.TELEPHONE:
(818) 348-3825
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY: 6CENSUS: 6DATE:
12/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Rimma GordonTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual visit. Upon arrival LPA met with staff and explained the reason for the visit. Administrator was contacted and arrived shortly.

LPA and staff toured the physical plant areas approximately 2pm: The facility has seven (7) bedrooms and eight (8) bathrooms currently occupying six (6) resident private bedrooms.  One (1) bedroom and one (1) bathroom is designated for staff use.  The facility is fire cleared for six (6) non-ambulatory residents, Hospice waiver for six (6). There is a dedicated area for the posting of required documents directly by the main entrance and hallway.

All resident bedrooms observed properly furnished with a bed, night stand, chair and sufficient lighting for each resident.  The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Extra linens are kept in cabinets in the hallway nearest bedroom. LPA observed a sufficient supply of linen, personal hygiene supplies, PPE, First aid kit and supplies stored at this location as well. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower.  The hot water temperature measured in all bathrooms ranged between 109-116 degrees Fahrenheit. Living and dining room furniture were also checked.   Dining room furniture were observed to be in good condition and appeared to be relatively clean. The facility maintains a comfortable temperature. The carbon monoxide/smoke detectors were tested and observed not functioning properly. Administrator contacted electrician during the visit and scheduled repair service. The fire extinguishers were fully charged and last serviced on 03/29/2025.  Kitchen area was sufficiently stocked with perishable and non-perishable food properly stored.  Frozen foods are properly wrapped and stored appropriately.  Food storage and preparation areas observed clean.   Knives and sharps are observed to be kept in a locked drawer to the left of the sink. (Continue to LIC 809c).

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2025
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: VILLA MULHOLLAND II
FACILITY NUMBER: 197604780
VISIT DATE: 12/18/2025
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 The backyard of the facility has outdoor furniture with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction.  There is no body of water in the facility. The garage is attached to the home and has an additional built in space/room which is only used as extra storage space according to staff. The garage also serve as storage for additional perishable and non-perishable  food,  other supplies and old equipment storage.  Laundry area is located along the kitchen hallway leading to the garage.  Laundry detergents, cleaning agents and other toxins are kept in the locked cabinet in the laundry area.

Approximately 2pm-3pm: LPA reviewed six (6) resident records for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Four (4) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were observed to be in order at this time.

Medications review began at approximately 3:30pm. The medications are centrally stored in the medication cabinet located near the laundry room.  Medications observed properly documented on the centrally stored medications and destruction record.



No deficiencies cited during this visit. Exit interview was conducted and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC809 (FAS) - (06/04)
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