197609651-1-6-2026-29-AS-TBYE-DQ3R87-20260106114727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609651
Report Date: 01/06/2026
Date Signed: 01/06/2026 11:47:37 AM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/06/2026 11:47 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:	VILLA CATHERINE SENIOR CARE FACILITY		FACILITY NUMBER:	197609651
ADMINISTRATOR/ DIRECTOR:	RUZANNA SUKIASSYAN		FACILITY TYPE:	740
ADDRESS:	7001 VAN NOORD AVE		TELEPHONE:	(818) 279-4309
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY: 6		CENSUS: 0	DATE:	01/06/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:27 AM
MET WITH:	Ruzanna Sukiassyan		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:27 AM. LPA contacted the facility Administrator Ruzanna Sukiassyan. The Administrator informed the LPA that the facility does not currently have any residents and no staff were located on site. The Administrator arrived to the facility at 10:01 AM. Entrance interview conducted and the reason for the visit was explained.

Beginning at 10:05 AM, the LPA, along with the facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are four (4) bedrooms in the facility; three (3) are dual occupancy rooms and one (1) is a single occupancy room. LPA and facility Administrator toured all four (4) bedrooms. All bedrooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All bedrooms were observed to contain direct exits to the outside of the facility.

BATHROOMS: There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared resident bathrooms and one (1) is designated as a staff bathroom. All bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured between 113.4 and 120 degrees Fahrenheit, which is in compliance with regulation.

Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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: VILLA CATHERINE SENIOR CARE FACILITY	FACILITY NUMBER: 197609651
	VISIT DATE: 01/06/2026

NARRATIVE

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KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. LPA observed a secured drawer which contained knives and other sharp objects. LPA observed secured cabinets designated to contain resident medication. LPA observed a camera covering the kitchen area. LPA confirmed with the facility Administrator that audio is not recorded. LPA observed a fire extinguisher mounted in the kitchen to be fully charged and last serviced on 02/05/2025.

COMMON AREAS: This included the living room, hallway, and dining room. LPA observed the dining room to be clean and properly furnished at the time of the visit. The dining room contained a dining table with adequate seating for resident use. The living room was observed to be clean and in good repair. The living room contained adequate seating and activities for resident use. LPA observed an appropriately screened fireplace located in both the living room and dining room. The facility’s combination fire and carbon monoxide alarms, as well as the facility fire doors, were tested at 10:42 AM. LPA observed Bedroom #1 to be missing a fire alarm and Bedroom #1’s fire doors to failed to close at the time of the test. LPA observed cameras located throughout the common areas of the facility. LPA observed all required postings located at the front entrance to the facility. LPA observed the PUB 475 poster to be smaller than the required 20" x 26" in size. LPA observed unsecured cleaning chemicals throughout the facility. LPA informed the Administrator that all noted corrections will need to be made prior to accepting clients into the facility’s care. The Administrator expressed understanding and agreed to comply.

OUTDOOR SPACE: The facility has three (3) emergency exit gates located on the perimeter fence of the facility; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed a locked storage building to contain facility maintenance supplies, and extra care supplies. An outdoor deck was observed to be connected to the living room and bedroom #1, bedroom #2, bedroom #3, and bedroom #4. All railings on the deck were properly secured and ramps appeared well lighted and non-slip. LPA observed cameras throughout the outdoor spaces of the facility. LPA observed an appropriately fenced off pool that was made inaccessible to potential clients in care. LPA observed a covered laundry area located on the side of the facility to contain a washer and dryer along with appropriate storage for cleaning chemicals. LPA observed a fountain at the front of the facility.

Continued on LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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: VILLA CATHERINE SENIOR CARE FACILITY	FACILITY NUMBER: 197609651
	VISIT DATE: 01/06/2026

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INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator.

As there were no residents in the care of the facility at the time of the inspection file review, medication review, and interviews were not conducted during today’s inspection.

During today’s visit LPA obtained a copy of the facility’s LIC 500, and liability insurance. LPA observed the liability insurance to be in the amount of at one million dollars ($1,000,000) per occurrence and two million dollars ($2,000,000) in the total annual aggregate. LPA informed the Administrator that the liability insurance is required to be in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate. The Administrator agreed to obtain the proper liability insurance prior to accepting clients into the facility’s care.

No deficiencies were cited during today’s inspection as no clients were in the care of the facility. Exit interview conducted and copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC809 (FAS) - (06/04)

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