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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607871
Report Date: 03/17/2026
Date Signed: 03/17/2026 01:42:44 PM

Document Has Been Signed on 03/17/2026 01:42 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:A BURBANK RESIDENTIAL CAREFACILITY NUMBER:
197607871
ADMINISTRATOR/
DIRECTOR:		GAYANE DZHAGARYANFACILITY TYPE:
740
ADDRESS:2020 SCOTT ROADTELEPHONE:
(818) 588-3916
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY: 6CENSUS: 4DATE:
03/17/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Levon Chalabyan - Co AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced Required - 1 Year annual inspection visit. Upon arrival LPA met with Administrator/Levon Chalabyan and explained the purpose of the visit. The program is vendorized through the Frank D. Lanterman Regional Center. The Adult Residential Facility is licensed for five (05) non-ambulatory and one (1) bedridden resident. Facility has approved hospice waiver for one (01) resident. Current census is four (4) ambulatory residents.

LPA toured the facility with the Administrator at 9:55 am and observed the following:



Required postings were observed by the entry area in the dining room. The front entry is the main exit door for emergencies. There are three (3) additional exits (by the kitchen, room# 2 and in the dining room) leading to the backyard. There are two (2) fire extinguishers, one (1) in the kitchen, one (1) in the hallway. Both fire extinguishers were purchased on 05/31/2025. Facility conducts bimonthly fire and safety drills. The last fire drill was conducted on 02/03/2026 and earthquake drill was conducted on 03/02/2026. The dual smoke alarms and carbon monoxide detectors are hardwired and interconnected. At 10:05 am the smoke/carbon monoxide alarms were tested and observed to function properly.

Kitchen: Appliances consisted of a refrigerator, stove, microwave and toaster oven. There is a breakfast nook with a table and six chairs. Knives, cutlery and other sharp kitchen utensils are stored and locked in the kitchen drawer. LPA found a sufficient amount of perishable (7 days) and non-perishable food supplies (2 days), stored in cabinets and refrigerator. LPA observed all food supplies marked with the purchase dates. Food storage and preparation areas and kitchen cabinets are maintained in clean and sanitary condition.

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NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2026
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: A BURBANK RESIDENTIAL CARE
FACILITY NUMBER: 197607871
VISIT DATE: 03/17/2026
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Common Areas: Include a living room, dining room and breakfast nook in the kitchen. The office area is located near the entrance/dining area. Dining room is furnished with a table and six (6) chairs. A non-functional fireplace with properly covered screen was observed in the dining room. The living room had a table and ample sitting for all the residents and staff. Television set and activity/gaming areas were observed in the living room.

Bathrooms: There are two (2) full bathrooms for the residents' use and one (1) half bathroom for staff use. All toilets and sinks are maintained in sanitary, operating condition. Functional grab bars and non-slip mats were observed in resident bathrooms. Hot water temperature was tested between 112.6 - 113.1 degrees Fahrenheit.

Bedrooms: There are six (6) bedrooms. Bedrooms designated for residents' use are #2,3,4,5,6. Bedroom#3 is a shared room (although currently is used as private use); bedroom #5 is currently vacant. All of the bedrooms were properly furnished with appropriate chairs, beddings, chest drawers, linens with sufficient lighting. A live-in staff is currently using bedroom #1 but there is awake staff at night. Bedroom #2 is designated as the bedridden room and has it's own exit door, leading to the backyard.

Surrounding grounds: Entry/exit gates and pathways were free of obstruction. The outdoor area was free of visible immediate hazards. No bodies of water were observed at the facility. There is ample patio space for outdoor activities. There was a covered patio area with furniture appropriate for outdoor use, sufficient for number of residents. Facilities garage is detached and has a bathroom and shower; although is not in use. The garage is currently used as storage and is kept locked. LPA observed two (2) refrigerators supplied with labeled perishable food items. LPA also observed chemicals and gardening tools, locked in the garage.


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NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: A BURBANK RESIDENTIAL CARE
FACILITY NUMBER: 197607871
VISIT DATE: 03/17/2026
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Laundry Room: Facility has brand new stackable washer and dryer, located in the hallway near the kitchen. All laundry detergents/chemicals and kitchen cleaners are stored in a locked cabinet in the laundry area, inaccessible to clients in care.

Resident Files/Medications: All resident records and medications were observed locked, in separate hallway closets. A review of four (4) resident records to ensure compliance of licensing forms was conducted. Medications records for all four (4) residents were also counted and verified for accuracy of administration based on physician orders; P&I was also counted for three (3) residents. LPA observed a complete first aid kit and first aid manual in the medication closet.

Staff Files: Records for five (5) staff members were reviewed to ensure all forms and training and first aid certificates are up to date.

Required documents: Administrator Certificate was observed with expiration date of 09/10/2026. Liability insurance has expiration date of 12/06/2026 and surety bond was recently issued on 02/14/2026. LIC610E Emergency and Disaster Plan for RCFE was updated on 03/16/2026.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / A Copy of the Report provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC809 (FAS) - (06/04)
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