197608534-3-24-2026-29-AS-ABAN-DSGNLK-20260324103339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608534
Report Date: 03/24/2026
Date Signed: 03/24/2026 10:34:04 AM

Document Has Been Signed on 03/24/2026 10:34 AM - 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:	ASSISTED COMFORT HOME		FACILITY NUMBER:	197608534
ADMINISTRATOR/ DIRECTOR:	MARIAM KEVLIYAN		FACILITY TYPE:	740
ADDRESS:	23731 KILLION STREET		TELEPHONE:	(818) 800-9970
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 6		CENSUS: 6	DATE:	03/24/2026
TYPE OF VISIT:	Office	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Mariam Kevliyan		TIME VISIT/ INSPECTION COMPLETED:	10:45 AM

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 Manager (LPM) Kristin Heffernan and Licensing Program Analyst (LPA) Angela Barutyan met with Licensee Representative/Administrator Mariam Kevliyan for this facility to hold an informal conference at the Woodland Hills North Adult and Senior Care Regional Office.

This informal conference was held to discuss a recent Unlicensed Operation, which was operated by the licensee representative and administrator of the licensed facility, Assisted Comfort Home.

On 01/27/2026, an application for RCFE Assisted Comfort Home #2 Lic. #195850734 was submitted for the property located at 23730 Killion St., Woodland Hills, CA 91367 which was in pending status as of today.

On 12/15/2025, the Woodland Hills North Adult and Senior Care Regional Office received a complaint alleging unlicensed care at Assisted Comfort Home. The complaint was unfounded as it was intended for the property located across the street from the Licensed facility. On 12/30/2025, the allegation of "Unlicensed Care" was substantiated for three (3) individuals at the 23730 Killion Street address and a Notice of Violation (NOVL) letter was issued to the operator, Ms. Kevliyan.

Therefore, this meeting was held to discuss the licensee representative's responsibilities and administrative qualifications and duties. The licensee representative, Mariam Kevliyan, stated that she understands that her actions were incorrect and that she takes full responsibilities for her actions.

LPM reviewed the definition of unlicensed care and provided Ms. Kevliyan a copy of Health and Safety Code (HSC) section 1569.10. Ms. Kevliyan indicated that moving forward, she will follow the HSC and Title 22 Regulations. Other issues related to the pending application for Assisted Comfort Home #2 were also discussed at the time of this visit.

Exit interview was conducted and a copy of report was issued.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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)

Page: 2 of 2