197609656-3-10-2026-29-AS-CYEE-DS32FE-20260310172124

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609656
Report Date: 03/10/2026
Date Signed: 03/10/2026 05:21:33 PM

Document Has Been Signed on 03/10/2026 05:21 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VAN NOORD MANOR		FACILITY NUMBER:	197609656
ADMINISTRATOR/ DIRECTOR:	MKRTCHIAN, VAHE		FACILITY TYPE:	740
ADDRESS:	6700 VAN NOORD AVE		TELEPHONE:	(818) 414-0005
CITY:	VALLEY GLEN	STATE: CA	ZIP CODE:	91606
CAPACITY: 4		CENSUS: 4	DATE:	03/10/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Vahe Mkrtchian, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and was let into the home by staff. LPA Yee met with Vahe Mkrtchian, Administrator. The reason for today's visit was provided. The facility is a single storey family home consisting of a living room, dining room, kitchen, four bedrooms of which one is used for live-in staff, 2 full common bathrooms and a attached garage. The swimming pool previously located in the backyard has been dismantled and the hole filled in. Permits were obtained. The facility is fire cleared for four (4) NON-AMBULATORY of which one (1) may be BEDRIDDEN. Bedroom #1 is currently designated for bedridden use. The facility has a hospice waiver for 4. The facility is vendorized by the North Los Angeles County Regional Center and is a Level 3 home. On today's visit all 12 domains of the CARE Inspection Tool was reviewed. Also reviewed were 4 resident and 5 staff files. A tour was conducted of the physical plant, inside and outside. The following was observed: The living room, dining room and kitchen had the appropriate furnishings and kitchen equipment for the four clients. Bedroom #1 is used as a double occupancy room and Bedroom #2 and Bedroom #3 are used as single occupancy. All 3 resident bedrooms have the required beds, chairs, night stand, lamps and closet. The required bed linens were observed. Blinds on the windows were observed. Bedroom #4 is designated for live-in staff and was toured. Both common bathrooms are equipped with a large walk-in shower, a toilet and a sink. Grab bars and continued on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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)

Page: 2 of 3

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: VAN NOORD MANOR	FACILITY NUMBER: 197609656
	VISIT DATE: 03/10/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 2.

non-skid mats were observed. The common bathrooms also contain a shower chair. The water temperature was tested in both bathrooms. The water temperature in the right bathroom read 111.4 degrees and the water temperature in the left bathroom read 114.6 degrees Fahrenheit.
The only fire extinguisher located in the kitchen was purchased on 1/23/26
The smoke/carbon monoxide combination detectors located in the resident hallway were tested and were operational
Sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed maintained on the premises
Medications are stored in the locked hallway closet
Knives are stored in a locked kitchen drawer
Cleaning solutions and disinfectants are stored in a locked cabinet under the sink and in the locked hallway closet.
First Aid kit was reviewed and contained the required scissors, tweezers and thermometer.
First Aid manual was observed.
No night lights were observed in the hallway.
The auditory devices on the exit doors were tested and were operational
Required posters were observed in the dining room, hallway and facility license by the front door
The facility has Liability insurance that meets the required $1 million per occurrence and $3 million annual aggregate.
The facility has a current surety bond.
The facility telephone,(818)308-7899 was tested and was operational
Located in the back is a covered patio is furnished with rattan sofa and 2 armchairs. Also located on the patio is a washing machine and dryer and was observed to be operational. The backyard was observed to be clean
The trash cans located in the front yard were tightly sealed.
Per tour of the front yard, there is a ramp leading from the front door. Designated area for smoking was observed. The front yard was observed to be clean.
Per tour of the garage, it is primarily used for storage.

No deficiencies were cited on today's visit.
Exit interview was conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026

LIC809 (FAS) - (06/04)

Page: 3 of 3