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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610176
Report Date: 01/20/2026
Date Signed: 01/20/2026 03:17:15 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/20/2026 03:17 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:ESSENTIAL CARE ASSISTED LIVINGFACILITY NUMBER:
197610176
ADMINISTRATOR/
DIRECTOR:		KHACHATRYAN, VERZHINEFACILITY TYPE:
740
ADDRESS:3132 WAVERLY DR.TELEPHONE:
(818) 284-7607
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY: 6CENSUS: 0DATE:
01/20/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Verzhine Khachtryan-AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 01/20/26, 2:05pm, Licensing Program Analyst (LPA) Raymond Comer conducted an unannounced Annual visit to this facility. An entry to the facility was allowed by the estate manager working at the property.
At the time of this visit there were no residents in the facility. LPA spoke with the Administrator over the phone and was informed that the facility has had no residents since January 2025. However, the licensee does not want to close facility.

The reason of this visit was discussed over the phone.

Facility is licensed as a single-story residence, approved for six (6) non-Ambulatory, with one (1) bedridden. Hospice waiver for six (6). Facility has four (4) resident bedrooms, and two (2) bathrooms.

At 2:25pm LPA conducted a tour of the physical plant and observed the following:

Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Alternative exits are located in all bedrooms. Visitor sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; wall thermostat displays a setting of 75.0°F. within the required range. An approved Mitigation and Infection Control plan is on file. Hand washing, coughing etiquette, and other necessary signage are prominently displayed throughout the facility. Required postings observed to be current. Disaster drills were last conducted on 12/2024.

[LIC 809C]-Continued---
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2026
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 4
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: ESSENTIAL CARE ASSISTED LIVING
FACILITY NUMBER: 197610176
VISIT DATE: 01/20/2026
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Kitchen: At 2:25pm, LPA observed kitchen as clean, equipped with a functional stove, refrigerator, with adequate supply of perishables and non-perishable food. Open pantry space stores dry food, condiments, and can goods. Emergency food is stored in a kitchen cabinets. Food is observed as properly labeled and stored. Kitchen cabinets store dishes, plastic, paper goods and utensils. Knives/Sharps are stored in a locked top drawer inaccessible to residents. No pesticides, nor toxins observed.

Medications are stored in a secured and locked cabinet located in the living room. A stocked first aid kit and manual was observed atop the med cart.i



Laundry LPA observed laundry room located in outside patio area. Laundry space observed to be clean and clear from obstructions. Soaps and other cleaning agents are stored and inaccessible to residents. LPA observed a storage cabinet containing towels, clean linen and blankets appearing sufficient for residents.

Commons: LPA observed all common areas of the facility, including the living room and dining room. LPA observed common areas to be clean and organized. Living room is supplied with sitting area, television, stored games, and reading materials. Fireplace in the living room area is screened, preventing access. No fireplace tools present. Furniture and fixtures are clean and good condition. Facility telephone is observed as operational.



Bedrooms: Bedrooms are clean with sufficient lighting, properly furnished with sufficient closet space, bedding, linens, and adequate furnishings.

Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hand towels and washcloths are not shared. Hot water temperature measured at 110.0°F. Within the required range.

Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. Backyard contains a swimming pool whose perimeter is fenced. Entry gate secured and locked, inaccessible to residents.

[LIC 809C]-Continued---

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

DATE: 01/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ESSENTIAL CARE ASSISTED LIVING
FACILITY NUMBER: 197610176
VISIT DATE: 01/20/2026
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Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. Backyard contains a swimming pool whose perimeter is fenced. Entry gate secured and locked, inaccessible to residents.

Facility records were not reviewed as the facility has no residents since January 2025 and no staff is working in the facility.

Exit interview was completed over the phone and the final report will be sent to the Administrator for manual signature.
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026
LIC809 (FAS) - (06/04)
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