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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609869
Report Date: 01/28/2025
Date Signed: 01/28/2025 08:26:36 PM

Document Has Been Signed on 01/28/2025 08:26 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:VALLEY VILLA SENIOR LIVINGFACILITY NUMBER:
197609869
ADMINISTRATOR/
DIRECTOR:		SIMITYAN, ARMENUIFACILITY TYPE:
740
ADDRESS:8315 SPARTON AVETELEPHONE:
(818) 994-5223
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY: 6CENSUS: 0DATE:
01/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Armenui SimityanTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. At 10:05 a.m. LPA Urena arrived at the facility and rang the doorbell several times and waited for a staff to answer the door; however, there was no response. At 10:37 a.m., the LPA called the Administrator, Armenui Simityan and informed them the reason for the visit, and asked about the facility staff not responding to the doorbell. The Administrator stated that they do not have any staff or residents at the current time. Facility had two residents living at the facility about two and a half months ago. One of the two residents, went back home, and the second resident relocated to a facility to be closer to their primary physician, consequently the facility is empty at the time of today’s annual inspection visit. Furthermore, the Administrator stated that they took the opportunity to do some cosmetic remodeling, such as painting inside and out, and adding new furniture to the facility. Administrator stated that they were not sure if they needed to inform the Community Care Licensing Department (CCLD) of the remodeling to the facility. LPA Urena reminded the Administrator that any changes, upgrades, or construction should be notified to the Regional Office (RO), via email, prior to starting any work that may affect the residents in care.
The LPA informed the Administrator that they needed to conduct the annual inspection. The Administrator stated that they were about an hour away from the facility. The LPA stated that they would wait for the Administrator to arrive.
At 12:15 p.m., the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations.

COMMON AREAS: The LPA observed common areas to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 08/25/2024. The fire alarms/carbon monoxide detectors were tested and functioned properly. All exits have functioning auditory devices and were operational at the time of the visit. Facility telephone was observed during the time of the visit. Medications and first aid kits are located in a locked storage closet in the office area.
Continues on LIC 809C...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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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: VALLEY VILLA SENIOR LIVING
FACILITY NUMBER: 197609869
VISIT DATE: 01/28/2025
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KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Laundry units are located next to the kitchen. Cleaning solutions and chemical items were inaccessible and locked away inside cabinets in the laundry area.

BEDROOMS: The facility is a single-story residential home with six (6) bedrooms, five (5) for resident use and one (1) for staff use and three (3) bathrooms. The bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level.

RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats, sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the restroom cabinets.

OUTDOOR SPACE: The back patio has a covered outdoor area for resident use. There are gates on each side of the house designated for an emergency exits. Passageways were free and clear from obstruction. There are no bodies of water on the premises. The garage is attached to the house and remains inaccessible to residents.

RECORDS: Residents’ records and Personnel records were not reviewed at this time due to facility not having any residents or staff at the time of the inspection visit. MEDICATIONS: Medications were not audited at this time due to facility not having any residents residing at the time of the inspection visit.

LPA Informed the Administrator that they need to inform the LPA when the remodeling is completed, and before accepting new residents. LPA will return to the facility to conduct a case management visit to ensure that all remodeling meets the departments criteria and regulations.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC809 (FAS) - (06/04)
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