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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609135
Report Date: 12/12/2025
Date Signed: 12/12/2025 03:21:30 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/12/2025 03:21 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:BURBANK HILLS COMFORT LIVINGFACILITY NUMBER:
197609135
ADMINISTRATOR/
DIRECTOR:		HANNESYAN, NARINEFACILITY TYPE:
740
ADDRESS:2745 N MYERS STTELEPHONE:
(818) 736-5097
CITY:BURBANKSTATE: CAZIP CODE:
91504
CAPACITY: 6CENSUS: 5DATE:
12/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Administrator, Narine HannesyanTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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At 10:00 AM Licensing Program Analyst (LPA), Nadia Shahbazian conducted an unannounced annual inspection at the facility. LPA met with the administrator, Narine Hannesyan and informed her of the reason for the visit. Facility is licensed to serve 6 non-ambulatory residents over the age of 60, of which 1 maybe bedridden. Facility has a hospice wavier for 3. At the time of inspection facility census is 5. Facility is a single story house, located in a residential neighborhood, consisting of a living/dining room, kitchen, 4 bedrooms, 1 staff bedroom, and 2 bathrooms.

At approximately 11:00 am LPA conducted a physical plant tour and observed the following:

Common Areas: Required postings were observed posted on the entry hallway. The entry hall was furnished with a dresser, which included a complete first aid kit and a first aid manual. The living room and dining area is a large space, with the office space in the corner of the dining room. The living area appeared to be clean and was properly furnished with seating for the capacity of the facility. LPA observed a screened fireplace in the living room, in addition there are games, magazines, television, telephone, cable and internet access. There is a refrigerator in the dining area with a fire extinguisher on top. The fire extinguisher was purchased on 01/08/2025. There is a locked, non-functional sliding door in the dining area.

Kitchen: LPA observed a refrigerator, stove, microwave oven, toaster over, dishwasher and all the appliances were functional. Sharp objects were locked in a drawer in the kitchen and cleaning solutions and detergents were locked in a cabinet. There is a large supply of dishes in the cabinets. Facility has perishable foods for two (2) days in the refrigerator and a supply of non-perishable foods for seven (7) stored in pantry and cabinets. All kitchen work surfaces, floors and walls were maintained in sanitary and clean condition.

Continued on LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2025
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BURBANK HILLS COMFORT LIVING
FACILITY NUMBER: 197609135
VISIT DATE: 12/12/2025
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Bedrooms/Bathrooms: The facility has five (5) bedrooms in total. The staff uses one of the bedrooms as sleeping quarter, but there is always awake staff in the facility. Bedroom #4 has a fire door and an exit door. There is an additional fire door in the hallway leading to bedrooms #1 through #3. Bedroom #2 has it's own full bathroom and there is another full bathroom between bedrooms #1 and #2. The water temperature in the bathroom was measured at 107.6 degrees Fahrenheit. All bedrooms contained a chair, night stand, dresser, lamp, and beds with adequate bedding.

Surrounding Grounds: The main entry door is used for the emergency exit. There is another exit gate in the front, which was kept unlocked and the path was free from debris. There was a fenced pool in the backyard, which is kept locked. The garage has been converted to a dwelling and is privately occupied. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. All walkways and exit passages were free of obstruction. There are two locked sheds in the backyard, one is used for storage and the other locked shed is where the washer and dryer and the laundry detergent/chemicals were kept, inaccessible to residents.

Smoke detectors/carbon monoxide. Carbon monoxide detectors and smoke detectors were located throughout the facility but were not interconnected. At 12:05 PM, smoke detector and carbon monoxide detectors were tested and observed to be operational.

Staff/Resident Files: The resident and staff files are kept locked in the staff bedroom. LPA conducted a file review of records for three staff, to ensure compliance of licensing forms and training. Records for all 5 residents were also reviewed and medications for 2 residents were counted and compared for accuracy of administration.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, Technical Advisory-deficiencies cited. Exit interview conducted. Appeal rights and copy of report provided to administrator.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

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

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