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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610483
Report Date: 12/17/2025
Date Signed: 12/17/2025 12:30:41 PM

Document Has Been Signed on 12/17/2025 12:30 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:LIFELONG SENIOR LIVINGFACILITY NUMBER:
197610483
ADMINISTRATOR/
DIRECTOR:		KAPIKYAN, ANDRANIKFACILITY TYPE:
740
ADDRESS:16003 LUDLOW STTELEPHONE:
(818) 371-5979
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 6DATE:
12/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Andranik Kapikyan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 12/17/25 at 09:25 AM, Licensing Program Analyst (LPA) Gina Saucedo arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA met with caregiver Gregory Valentine and disclosed the purpose of the visit. The administrator, Andranik Kapikyan was called and arrived about an hour later.

LPA asked for the census, resident, and staff rosters. A physical tour was conducted at 9:55 AM and observed the following:



The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. There is one (1) fire extinguisher located in the living room fully charged and dated 12/2024. There is extra, food in the kitchen pantries. The knives are located in one (1) of the kitchen counters on your left-side locked and inaccessible to the residents.

The medications are locked and inaccessible to the residents in a storage room on your right-hand side at the entrance of the facility.

Outside/Backyard: The outside/backyard has furniture for the residents with proper seating. The facility does have a signal system. There are cameras in common areas. The facility does not have a pool/body of water.

LIC 809C-continued
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2025
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: LIFELONG SENIOR LIVING
FACILITY NUMBER: 197610483
VISIT DATE: 12/17/2025
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Bedrooms/Bathrooms: There are four (4) bedrooms designated for resident's use. All bedrooms, in use by the residents were observed to be properly furnished with appropriate beddings and linens, with sufficient lighting. There are two (2) bathrooms designated for resident's use. One (1) bathroom is located in the hallway and the other bathroom is a private bathroom in a resident's room. Hot water temperature was measured between 113 and 113.5 degrees Fahrenheit.

The dining/living room area has enough seating for the residents and the staff. There is no fireplace.

The house temperature is at 72-degree Fahrenheit.

The smoke detector/carbon monoxide is in the hallway and is operable.



The washer/dryer are located outside and can be accessed from the kitchen area. There is one (1) washer/dryer.

Administrative: In the dining room/living room are on your left-hand side there is a billboard with the Ombudsman sign, Admission Agreement, Rights of Resident Council, Infection Control and the surety bond with an expiration date of 02/15/26.

Staff/Resident Files: Two (2) staff files were reviewed and six (6) resident files.

Garage: The garage is a converted ADU. The ADU has it's own separate entry. It is inaccessible to the residents in care. There is an address for the ADU which is 16001 Ludlow Street, Granada Hills, CA 91344.

The 02/21/2023, the LIC 850 specifically stated that the garage would be an ADU and not included in the fire clearance. The certificate of occupancy was finalized on 10/17/2023 and the Building and Safety permit was finalized on 09/18/2023.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was issued to the Administrator.
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC809 (FAS) - (06/04)
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