<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610470
Report Date: 10/16/2025
Date Signed: 10/16/2025 11:56:31 AM

Document Has Been Signed on 10/16/2025 11:56 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:BIG HEARTS RESIDENTIAL LIVINGFACILITY NUMBER:
197610470
ADMINISTRATOR/
DIRECTOR:		BOTE, ELAINE P.FACILITY TYPE:
740
ADDRESS:22901 CANTLAY STTELEPHONE:
(818) 914-4254
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 6CENSUS: 6DATE:
10/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Matias CalibaraTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At approximately 9:15 a.m. on 10/16/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an annual inspection. LPA met with staff and disclosed the reason for the visit.

The facility is a single story building with six (06) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) residents, of which five (05) may be nonambulatory and one (01) bedridden in Bedroom #5. The facility serves residents with dementia.

LPA observed a maintained front yard with gardened areas. The walkway leading to the main entrance was free of debris. Postings located at the front and side living room included the administrator’s certificate, personal rights, rights of resident councils, facility sketch with evacuation routes clearly labeled, confidential complaint poster, Ombudsman contact poster, house rules, facility license, emergency disaster plan, and emergency contacts.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 9:25 a.m. LPA measured the room temperature to be 75 degrees Fahrenheit. The hallway contained night lights and a closet for hygiene supplies. A fully charged fire extinguisher was observed near the kitchen. It was last inspected on 09/10/25. The front living room contained exercise equipment, puzzles, board games, a television, and furniture in good repair. The side living room contained emergency water, confidential files, locked medications, and exercise equipment. A washing machine and dryer were located in the garage. Both were in working order. Detergents were locked in a storage shed. The garage stored additional supplies.

The facility has two (02) bathrooms. The bathroom designated for residents contained liquid soap, paper towels, grab bars and a non-skid mat in the shower, and a commode with grab bars.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2025
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 7
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)
Page: 2 of 7
Document Has Been Signed on 10/16/2025 11:56 AM - It Cannot Be Edited


Created By: Nicholas Reed On 10/16/2025 at 11:24 AM
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: BIG HEARTS RESIDENTIAL LIVING
FACILITY NUMBER: 197610470

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87606(c)
Care of Bedridden Residents
(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in one (01) out of six (06) residents which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2025
Plan of Correction
1
2
3
4
Licensee to consult with the resident's family and primary care physician regarding their ambulatory status and placement options.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Naira Margaryan
NAME OF LICENSING PROGRAM MANAGER:
Nicholas Reed
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2025


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 10/16/2025 11:56 AM - It Cannot Be Edited


Created By: Nicholas Reed On 10/16/2025 at 11:24 AM
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: BIG HEARTS RESIDENTIAL LIVING
FACILITY NUMBER: 197610470

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87458(c)(1)(A)
Medical Assessment
(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two (02) out of six (06) residents which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/27/2025
Plan of Correction
1
2
3
4
Licensee to obtain chest exams or TB results for the two (02) residents without documented TB test results by the POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Naira Margaryan
NAME OF LICENSING PROGRAM MANAGER:
Nicholas Reed
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2025


LIC809 (FAS) - (06/04)
Page: 4 of 7
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: BIG HEARTS RESIDENTIAL LIVING
FACILITY NUMBER: 197610470
VISIT DATE: 10/16/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
It needed some minor repairs to the shower head which was leaking. At approximately 9:45 a.m. LPA measured the water temperature in the resident bathroom to be 108.5 degrees Fahrenheit.

The facility has six (06) bedrooms. One (01) bedroom is designated as a staff room. The staff room was unlocked and free of hazards. Four (04) out of five (05) resident bedrooms contained a chair, lamp, nightstand, dresser, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Bedroom #1 did not have a chair or lamp and contained a resident, Resident #1 (R1), who was bedridden. Review of the facility sketch and fire clearance at 10:30 a.m. today revealed Bedroom #5 was the only bedroom designated for a bedridden resident. Review of R1’s medical assessment at 10:35 a.m. revealed they were bedridden. A deficiency is cited for this violation on the corresponding LIC 809-D page.

LPA observed an adequate supply of perishable and non-perishable foods stored in the refrigerator, freezer, and pantry. The stove and surfaces were clean. Appliances were in good condition. Sharps were locked below the countertop. Cleaning solutions were locked below the sink.

LPA observed a covered patio area in the rear of the facility. The patio contained shaded furniture in good condition. A locked storage shed contained additional supplies. The emergency exit path was free of debris. The exit gate was unlocked. Three (03) out of three (03) auditory alarms were turned on and functioning.

LPA reviewed personnel and resident files at 10:00 a.m. All files were available for audit. At approximately 10:35 a.m. LPA observed that Resident #1 (R1) and Resident #2 (R2) did not have tuberculosis tests or chest exams. This deficiency is cited on the corresponding LIC 809-D page.

At 11:05 a.m. the house phone was called and confirmed to be functional. At approximately 11:10 a.m., smoke and carbon monoxide detectors were tested and operational.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

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

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC809 (FAS) - (06/04)
Page: 5 of 7