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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610014
Report Date: 10/07/2025
Date Signed: 10/07/2025 02:30:24 PM

Document Has Been Signed on 10/07/2025 02:30 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:RITE CARE ASSISTED LIVING CHFACILITY NUMBER:
197610014
ADMINISTRATOR/
DIRECTOR:		MAMYAN, NARINEFACILITY TYPE:
740
ADDRESS:829 N. CRESCENT HEIGHTS BLVD.TELEPHONE:
(818) 433-5622
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY: 6CENSUS: 3DATE:
10/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Ruzanna Sukiassyan- AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 10/07/25, at 10:15am, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct an unannounced annual visit of the facility. LPA met with Facility Administrator, Ruzanna Sukiassyan, and reason for the visit was disclosed.

Facility is licensed as a single-story residence; fire clearance is licensed for six (6) non-ambulatory residents; ages 60 and older. Two (2) residents may be bedridden; hospice waiver is for four (4) residents. Facility has four (4) bedrooms, and two (2) bathrooms. Currently, there are (1) residents receiving hospice services.

At 10:40am, LPA conducted a tour of the physical plant with the Administrator, and observed the following:

Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access point. Emergency exits are at the rear of the living room area. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, and other related signage is posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 74.0°F; within the required range. Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on 6/15/2025.

Fire detection: Sensors (Dual smoke carbon monoxide detectors) are located throughout the facility. Detectors were tested and function properly. LPA observed one fire extinguisher hanging on the wall in the kitchen area; last service date was 9/20/25.
[LIC 809C]-Continued
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2025
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: RITE CARE ASSISTED LIVING CH
FACILITY NUMBER: 197610014
VISIT DATE: 10/07/2025
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KITCHEN: LPA observed kitchen as clean, equipped with a functional stove, multiple appliances, and stocked with an adequate supply of perishable and non-perishable foods. Emergency food is stored and locked in pantry cabinets near the kitchen area. Food is observed as properly labeled and stored. Kitchen cabinets contain dishes, plastic, paper goods and utensils. Knives and sharps are stored and locked in kitchen drawer, inaccessible to residents.

MEDICATIONS: Medication room is located in a living room storage closet; area was found locked and inaccessible to residents. Facility has fully stocked first aid kit and manual located and in the medication area. However, centrally stored prescription and PRN medication has NOT been logged showing medication dispensing charting. Deficiency will be cited on LIC 809-D.

LAUNDRY: LPA observed the laundry room located in storage room across from the kitchen area. Laundry machines, soaps, and other cleaning agents are secured and inaccessible for residents. Linen storage was observed to have adequate supply of linen and towels.

GARAGE: There is no garage at the facility; only a driveway in the front of the facility.

COMMONS: LPA observed all common areas of the facility, including the resident dining area. LPA observed common areas to be clean, organized, properly furnished and in excellent condition. Facility is furnished with piano, television, reading materials, and board games for residents use.

BEDROOMS: All bedrooms are observed as clean and clear of clutter, with sufficient lighting, properly furnished with bedding, linens, and at least one chair, and night stand.

BATHROOMS: All bathrooms were observed to be clean and sanitary with necessary supplies, and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 108.0°F. Within the required range.

OUTDOOR: The (backyard) area observed to have a shaded patio, with table, and sufficient seating for the residents. Outdoor furniture was observed to be in good condition. A storage shed in the backyard contains PPE and incontinent products for residents; shed was observed as locked during the visit. Outdoor area observed as clean and clear from obstruction. No bodies of water are located on the premises.

[LIC809C]-Continued

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: RITE CARE ASSISTED LIVING CH
FACILITY NUMBER: 197610014
VISIT DATE: 10/07/2025
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RESIDENT RECORDS: Records were located in the living room storage closet; locked and inaccessible to residents. A total of three (3) resident files were reviewed for current IPP and/or Needs and Services plans, physician report, admission agreements and all relevant documents. Resident records appeared to be complete and current.

STAFF RECORDS: Records were located in the living room storage closet; locked and inaccessible to residents. A total of four (4) Staff files were reviewed. Criminal record clearances were present, and Staff are associated to this facility. Staff records appear to be complete and current.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D.

Exit interview conducted, appeal rights and copy of report signed and delivered.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/07/2025 02:30 PM - It Cannot Be Edited


Created By: Raymond Comer On 10/07/2025 at 01:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: RITE CARE ASSISTED LIVING CH
FACILITY NUMBER: 197610014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(d)(3)
Incidental Medical and Dental Care Services
(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Raymond Comer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/07/2025 02:30 PM - It Cannot Be Edited


Created By: Raymond Comer On 10/07/2025 at 01:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: RITE CARE ASSISTED LIVING CH
FACILITY NUMBER: 197610014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(d)(3)
87465(d)(3) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication...facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in three] out of total three resident medication records which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2025
Plan of Correction
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Administrator has agreed to provide facility staff vendored Medication distribution and Medication Administration Record (MAR) training. Proof that certified trainer has provided training and list of staff attendees shall be provided to LPA by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Raymond Comer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2025


LIC809 (FAS) - (06/04)
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