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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609801
Report Date: 08/12/2025
Date Signed: 08/12/2025 02:46:12 PM

Document Has Been Signed on 08/12/2025 02:46 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LAND OF PEACE 5FACILITY NUMBER:
197609801
ADMINISTRATOR/
DIRECTOR:		ROSELIN FINULIARFACILITY TYPE:
740
ADDRESS:22625 KITTRIDGE STREETTELEPHONE:
(818) 883-3356
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 6CENSUS: 6DATE:
08/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Roselin FinuliarTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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At 8:30 a.m. on 08/12/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the administrator and disclosed the reason for the visit.

The facility was last visited on 07/23/24 for an annual visit. It is a single story building with six (06) bedrooms, three (03) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) residents, of which five (05) may be non-ambulatory and one (01) bedridden in Bedroom #4. The facility serves residents with dementia. Approved hospice waivers for six (06).

LPA and the administrator toured the facility inside and out. The front yard was maintained with gardened areas. At the main entrance, LPA observed postings for the facility license, rights of resident councils, personal rights, resident rights, emergency disaster plan, confidential complaint contacts, ombudsman contacts, neighborhood complaint policy, house rules, administrator certificates, and a blank copy of the admission agreement. A sign indicating "No smoking - Oxygen in use" was posted on the front door and on the door to Bedroom #5. A screening station contained a visitor log, digital thermometer, and hand sanitizer.

The facility has six (06) bedrooms. One (01) bedroom is designated as a staff room. The staff room was locked and free of hazards. All bedrooms contained a chair, nightstand, call button, appropriate lighting, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. All hospital-style beds had wheels in the locked position.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 10:10 a.m. LPA measured the room temperature to be 78 degrees Fahrenheit. The living room contained board games, puzzles, reading material, a television, and furniture in good condition. The fireplace was appropriately covered.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2025
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LAND OF PEACE 5
FACILITY NUMBER: 197609801
VISIT DATE: 08/12/2025
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 Three (03) residents were observed watching television in the living room. Cameras were observed in common areas. At 10:15 a.m. LPA called the house telephone and verified that it was functioning properly.

LPA observed an adequate supply of perishable and non-perishable foods in the kitchen and the garage. The stove hood was clean. Appliances were in good condition. At approximately 10:30 a.m. LPA observed a fully charged fire extinguisher near the kitchen. Sharps were locked by the refrigerator. Cleaning solutions were locked above the washer and dryer. Medications were locked above the counter top. The washing machine and dryer were both in working order.

LPA observed a covered patio area in the rear of the facility. The patio was shaded and contained furniture in good condition, extra equipment, and emergency water supplies. The ramp leading out was free of debris and had sturdy rails. Two (02) out of two (02) emergency exit paths were free from obstructions. Evacuation routes were posted and labelled. Five (05) out of five (05) auditory alarms were turned on and functioning. The garage was inaccessible and contained extra supplies and gardening tools.

The facility has three (03) bathrooms. All bathrooms contained liquid soap, paper towels, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 10:45 a.m. LPA measured the water temperature in the shared bathroom to be 108.4 degrees Fahrenheit. At approximately 11:00 a.m., smoke and carbon monoxide detectors were tested and operational. Detectors functioned simultaneously, and the fire door in the hallway closed securely. At approximately 11:10 a.m., LPA and staff conducted a medication review for three (03) residents. All resident medications were maintained in the correct quantities.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed during today’s visit.

Exit interview conducted. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC809 (FAS) - (06/04)
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