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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609055
Report Date: 10/10/2025
Date Signed: 10/10/2025 03:12:04 PM

Document Has Been Signed on 10/10/2025 03:12 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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SK MARATHON HOME CAREFACILITY NUMBER:
197609055
ADMINISTRATOR/
DIRECTOR:		KIM, SUN ILFACILITY TYPE:
740
ADDRESS:7246 FALLBROOK AVETELEPHONE:
(818) 912-6757
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 6CENSUS: 5DATE:
10/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Sarah KimTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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At approximately 12:45 p.m. on 10/10/2025, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

The facility was last visited on 09/05/24 for an annual inspection. It is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for five nonambulatory (05) residents, of which one (01) may be bedridden in Bedroom #2. The facility serves residents with dementia. Approved hospice waivers for four (04).

At the main entrance, LPA observed an unlocked gate, exercise equipment, a shaded seating area, and a ramp leading to the front with sturdy handrails. LPA observed postings for confidential complaint contacts, emergency contacts, ombudsman contacts, personal rights, rights of resident councils, emergency disaster plan, facility sketch with evacuation routes labeled, administrator certificate, and facility license.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 12:55 p.m. LPA measured the room temperature to be 79 degrees Fahrenheit. The living room contained furniture in good repair, an appropriately covered fireplace, games, puzzles, reading material, music, and television. The hallway closet contained additional hygiene supplies. A camera was used to monitor the living area. Four (04) out of four (04) residents were observed relaxing in the living room.

LPA observed an adequate supply of perishable and non-perishable foods in the kitchen and dining area. The stove hood was clean. Appliances were in good condition. Sharps were locked above the countertop. Cleaning solutions were locked next to the sharps. Medications were locked in a separate cabinet in the dining area. A washing machine and dryer were located outside of the kitchen.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2025
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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SK MARATHON HOME CARE
FACILITY NUMBER: 197609055
VISIT DATE: 10/10/2025
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Both were in working order. Detergents were locked above the appliances.

The facility has four (04) bedrooms. One (01) bedroom is designated as a staff room. The staff room was locked and free of hazards. All bedrooms contained a chair, appropriate lighting, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Two cracks were observed in the ceiling in the hallway and in Bedroom #3. Interview with Staff #1 (S1) at approximately 1:15 p.m. revealed a maintenance man caused the cracks when fixing the air conditioning. S1 noted they will consult with the property owner about repairs. At 1:20 p.m. S1 called the house telephone and verified that it is operating.

The facility has two (02) bathrooms. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 1:30 p.m. LPA measured the water temperature to be 105.4 degrees Fahrenheit.

All emergency exit paths were free from obstructions. Exit gates were unlocked with self-closing latches. Four (04) out of four (04) auditory alarms were turned on and functioning. S1 noted that the facility recently installed a centralized auditory alarm system. At approximately 1:45 p.m., smoke and carbon monoxide detectors were tested and operational. At approximately 1:50 a.m. LPA observed a fully charged fire extinguisher in the kitchen.

LPA observed a shaded patio area in the front of the facility. The patio contained furniture in good condition. Ramps leading out were free of tripping hazards and had secure hand rails. The back yard contained fruit-bearing trees and exercise equipment.

At 2:00 p.m., LPA conducted a file review of resident and personnel records. All files were available for audit.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed.

Exit interview conducted. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC809 (FAS) - (06/04)
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