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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609495
Report Date: 12/18/2025
Date Signed: 12/18/2025 01:54:59 PM

Document Has Been Signed on 12/18/2025 01:54 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:WOODLAKE LOVING CARE LLCFACILITY NUMBER:
197609495
ADMINISTRATOR/
DIRECTOR:		ARDAKANI, SHAKILAFACILITY TYPE:
740
ADDRESS:8016 WOODLAKE AVETELEPHONE:
(818) 217-6778
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY: 6CENSUS: 5DATE:
12/18/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Shakila Ardakani - Administrator TIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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On 12/18/25, Licensing Program Analysts (LPAs) Perchuhi Milena Khurshudyan and Tihesha Smith, conducted an unannounced Case Management visit to this facility. Upon arrival LPAs met with Shakila Ardakani Administrator and explained that the reason for this visit is to continue an investigation of the case management visit initiated on 12/08/2025.

The purpose of today’s visit is to address issues and concerns regarding admission, readmission, and retention of resident #1 (R1) to the facility.

On 10/17/25, LPA Khurshudyan received an Incident Report (IR) regarding R1, who developed wound on the right toe and per home health nurse evaluation R1 required antibiotic. On 10/23/25, LPA received another Incident Report regarding R1 being transferred to hospital due to wound infection on the toe.

Prior to this visit LPAs Smith and Khurshudyan reviewed all available documents pertaining to R1’s health conditions. Upon further review of available medical records, including but not limited to Home Health, records, wound evaluate R1’s health condition, care plan, and the facility’s improper assessment practices related to R1’s return from the hospital.

During this visit at approximately 1:20pm, LPAs conducted a brief physical plant tour to ensure health and safety of the residents are protected. No health and safety hazards noted during the visit. Between 10:45am to 12:00pm, LPAs spoke with facility Administrator and reviewed additional medical records.

Continue on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WOODLAKE LOVING CARE LLC
FACILITY NUMBER: 197609495
VISIT DATE: 12/18/2025
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Overall investigation revealed that on or before 10/17/25, R1 developed pressure injury(s) on their right toe and other pressure points including buttock. R1 was receiving home health care assistance. However, the wound(s) was not healing, and wound care specialist was contacted to attend R1 for further assistance. Between 10/17/25 and 10/23/25, the condition of the pressure injury(s) worsened and R1 was sent to the hospital. At the time of admission to the hospital, R1 was diagnosed with multiple unspecified pressure injuries and Sepsis.

Hospital records state that resident was recommended to continue medical care in skilled nursing facility. However, per R1’s family request and refusal to transfer R1 to skilled nursing facility (SNF), R1 was readmitted back to the facility. R1 was discharged back to the facility with PICC/IV line for continuation of care. The hospital discharge records did not provide any information to verify that R1’s Sepsis was colonized, and the pressure injuries were healing.

Overall investigation revealed that while in the facility R1 developed prohibited health condition, was hospitalized and later on 10/28/25 was readmitted to the facility without proper discharge record identifying the status of the infection and pressure injuries.
Based on inspection, observation and record review the following citation was issued and recorded on LIC809D.

An immediate $500.00 Civil Penalty will be issued for retention and readmission of the residents with prohibited health condition.

Deficiency issued during today’s visit, check LIC809D pages.

Exit interview conducted, copy of this report signed and delivered.
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
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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Document Has Been Signed on 12/18/2025 01:55 PM - It Cannot Be Edited


Created By: Perchui Khurshudyan On 12/18/2025 at 01:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: WOODLAKE LOVING CARE LLC
FACILITY NUMBER: 197609495

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/19/2025
Section Cited
CCR
87615(a)(4)

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87615 Prohibited Health Conditions (a)Persons who require health services for{...}including, but not limited to{...} shall not be admitted or retained in a residential care facility for the elderly: (4)Staphylococcus aureus ("staph") infection or other serious infection. This This requirement was not met as evidenced by"
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The Administrator will submit written statement explaining the actions will take before admitting residents to facility to avoid similar situations in future.
An immediate $500.00 Civil Penalty will be issued for retention and readmission of the residents with prohibited health condition.
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Based on records reviewed and interview held with Administrator which revealed that R1 was re-admitted to the facility with prohibited health condition, which posed an immediate health and safety and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Perchui Khurshudyan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2025


LIC809 (FAS) - (06/04)
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