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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609643
Report Date: 05/08/2025
Date Signed: 05/08/2025 01:42:32 PM

Document Has Been Signed on 05/08/2025 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VALERIO CASTLE INCFACILITY NUMBER:
197609643
ADMINISTRATOR/
DIRECTOR:		HAKOBYAN, ANNAFACILITY TYPE:
740
ADDRESS:15360 VALERIO STTELEPHONE:
(310) 435-1445
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 4CENSUS: 4DATE:
05/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Anna Hakobyan TIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. Upon arrival LPA met with the Administrator Anna Hakobyan and explained the reason for the visit. The facility serves level 3 clients from North Los Angeles County Regional Center.

LPA Urena and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a single-story residence and has (2) private bedrooms and one (1) shared bedroom for resident use and one (1) bedroom designated for staff. At the time of the visit, two (2) residents were attending day program, and two (2) residents were observed at the facility. The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. Fire extinguisher was observed fully charged and purchased on March 12, 2025.

COMMON AREAS: Including the dining and living room, these were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and/or activity supplies in the living room and dining area. Night lights were maintained in hallways and passageways to non-private bathrooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. There is a functioning telephone on the premises. Required postings were observed by the entrance hallway. A chimney was observed in the living room area. The chimney was covered and non-functional at the time of the visit.
Continues on LIC 809C...
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2025
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VALERIO CASTLE INC
FACILITY NUMBER: 197609643
VISIT DATE: 05/08/2025
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KITCHEN: Knives and sharp objects are stored in the top drawer to the right of the sink. LPA observed it to be inaccessible to residents in care. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry, and house cleaning supplies are stored in the garage inaccessible to residents in care. The first aid kit was observed in the kitchen, and it is complete and included a current version of a first aid manual.

BEDROOMS: All rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Each bedrooms have its own supply of linens stored in the closet.

BATHROOMS: There is one (1) bathroom in the common area designated for resident use. Hot water temperature measured at 111.5 F degrees at the time of visit. The resident’s bathroom has a shower with non-skid materials and mats. The toilet and shower have grab bars. The bathroom nearest to the kitchen is designated as a staff restroom. The hot water temperature was tested in the staff bathroom and in the kitchen and was found to be within the range of 105*F and 120*F degrees. Bathroom located in master room is not in use, inside there are PPE supplies, emergency supplies, linen and extra towels. This room has a “For Employees Only” sign and it is locked at all times. The LPA had a conversation with the Administrator about the facility sketch, which describes the master bathroom designated as a bathroom and not for storage use. The Administrator stated that an updated facility sketch was submitted to the Department for approval. The Administrator will provide proof of the approval of the updated facility sketch.

LAUNDRY ROOM: Located between the garage and the kitchen. Personal hygiene items (shampoos, soaps) were adequate and are stored in a cabinet above the washer and dryer.

Continues on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VALERIO CASTLE INC
FACILITY NUMBER: 197609643
VISIT DATE: 05/08/2025
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OUTDOOR SPACE: At the time of the visit, the back patio area of the house had a table and chairs out of reach. The Administrator was advised to bring the patio table, chairs and umbrella to the top area of the patio for residents’ use. The front of the house has a shaded area for residents use.
During today’s visit, LPA Urena observed an accessory dwelling unit (ADU) in the back patio. Per the Administrator, an accessory dwelling unit (ADU) was constructed by the property owner. Furthermore, LPA Urena advised the Administrator that a barrier will have to be added to separate the facility from the ADU and to ensure that the fence will meet the fire safety guidelines. The barrier has to be completed in 15 days (05/23/2025) from today’s date.
On 05/10/2024, LPA Valeria Conway conducted the required annual inspection and requested that the administrator keep LPA Conway updated with the progress of the construction and submit an updated facility sketch upon completion. Discussion was also held regarding staff prioritizing safety measures to ensure all residents are safe during the construction. Additionally, LPA Conway also informed administrator that any individual that is living in the ADU should be fingerprinted and associated to the facility prior to residing.
There are no bodies of water on the premises at the present time. Garage is attached to the home and was observed to be inaccessible to residents in care. LPA observed the garage locked and to store emergency food supplies, extra non-perishable foods, PPE, medical supplies and incontinent supplies.
RECORDS: Records review began at 12:45 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 01:45 p.m.; medications are centrally stored and locked in a cabinet in the kitchen area next to the refrigerator; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

The LPA reviewed the following documents:


- LIC500 Personnel Report
- LIC9020 Client Roster
- Certificate of Liability of Insurance
- Emergency Drill Logs
No citations were issued. Exit interview conducted. A copy of the report was issued.
NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Sandra Urena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC809 (FAS) - (06/04)
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