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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610277
Report Date: 03/19/2025
Date Signed: 03/19/2025 11:00:20 AM

Document Has Been Signed on 03/19/2025 11:00 AM - 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:NORTH HILLS VILLAFACILITY NUMBER:
197610277
ADMINISTRATOR/
DIRECTOR:
TER-ARSENYAN, ARSENFACILITY TYPE:
740
ADDRESS:16437 PARTHENIA STTELEPHONE:
(424) 444-9998
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 0DATE:
03/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Arsen Ter-ArsenyanTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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At approximately 9:30 a.m. on 03/19/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with the administrator and disclosed the reason for the visit. A file review was conducted prior to today’s visit. The facility was last visited on 10/14/2022 for a prelicensing visit. It is a single story building with seven (07) bedrooms, two (02) bathrooms, kitchen, laundry room, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents. Approved hospice waivers for four (04). Upon arrival, the administrator informed LPA that there are no staff or residents currently residing in the facility. The facility is waiting on eligibility for the Assisted Living Waiver Program and is operating as an independent living home with six (06) tenants who perform all activities of daily living independently without the need for licensed care and supervision. LPA observed a maintained front yard with a variety of trees and plants. Postings in the kitchen included confidential complaints contacts, emergency disaster plan, rights of resident councils, personal rights, and the facility sketch. Walls, floors, windows, screens, and blinds were clean and in good repair. At 9:40 a.m. LPA measured the room temperature to be 75 degrees Fahrenheit. The living room contained a television, reading material, and furniture in good repair. A fireplace was appropriately covered and turned off. The facility has seven (07) bedrooms. One (01) bedroom is designated as a staff room. The staff room was unlocked and free of hazards. Other bedrooms were locked and unoccupied. The facility has two (02) bathrooms. Bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars near the shower, and a non-skid mat in the shower. At approximately 10:00 a.m. LPA measured the water temperature in Bathroom #1 to be 119.6 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. Appliances were in good condition. Cleaning solutions were locked under the sink. Sharps were locked above the counter top. The stove surface and hood were clean. The medication storage area was locked and located near the refrigerator. A washing machine and dryer were located in the laundry area. Both were in working order. Two (02) out of two (02) emergency exit paths were free from obstructions. Exit gates were unlocked. At 10:05 a.m., smoke and carbon monoxide detectors were tested and operational. At approximately 10:15 a.m. LPA observed a fully charged fire extinguisher in the kitchen. During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health or safety hazards were observed. Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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