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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610603
Report Date: 10/30/2025
Date Signed: 10/30/2025 02:09:12 PM

Document Has Been Signed on 10/30/2025 02:09 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:GOLDEN YEARS SENIOR LIVINGFACILITY NUMBER:
197610603
ADMINISTRATOR/
DIRECTOR:		IREN PLOKHOVAFACILITY TYPE:
740
ADDRESS:12501 BRADFORD PLTELEPHONE:
(818) 217-4524
CITY:GRANANDA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 5DATE:
10/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Iren PlakhovaTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Iren Plakhova, and explained the reason for the visit.

At approximately 9:15am, LPA took a tour of the physical plant. The facility is a one story building. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual, hardwired and interconnected. There are two fire extinguishers. One is located in the kitchen, and the other is located at the hallway. Fire extinguisher was purchased on April 22, 2025.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food sealed and properly stored. Knives were stored in a locked drawer in the kitchen. Cleaning supplies were stored locked underneath the kitchen sink.

BEDROOMS: There are a total of five (5) bedrooms. Rooms #1 and #4 are shared. Rooms #2 and #3 are private. Room #5 is currently designated for staff use, but has a fire clearance for Ambulatory only. Room #4 has the bedridden fire clearance. Bedrooms were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Hallways and passageways are clear of any obstruction.

BATHROOMS: The facility has three (3) bathrooms. Two bathroom are for resident use. One bathroom is for staff. Bathrooms designated for residents were observed to have the proper fixtures, grab bars, and non-skid mats. Staff bathroom is locked and inaccessible to the residents. The hot water delivered in the resident bathrooms measured between 111 and 114 degrees.
NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Michael Cava
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2025
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: GOLDEN YEARS SENIOR LIVING
FACILITY NUMBER: 197610603
VISIT DATE: 10/30/2025
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Common Areas: Common areas include the living room, family room and dining room. The living room and family room is furnished with sufficient seating, couches, chairs, tables and television. There is a fireplace in the living room that is properly screened. No tools present. The dining room table is large enough to seat up to six (6) individuals. Furniture and floors are maintained and in good repair.

LAUNDRY ROOM: The laundry room is located by staff room (room #5). Laundry detergents and cleaning supplies are maintained in the laundry room. Laundry room is kept locked.

Staff Workstation/Office: There is a staff station located at the corner of the living room where resident and staff files are kept.

MEDICATIONS: Medications are stored locked in a kitchen cabinet. Medication and Medication Records were reviewed for proper storage and documentation.



RESIDENT RECORDS: LPA conducted a file review of resident records to insure compliance of licensing forms.

STAFF RECORDS: LPA conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

GARAGE: The garage is attached to the home. Entry is at the kitchen. It requires a combination code to gain access. Garage is used for storage space. There are two extra refrigerators and a freezer for an additional food supply.

SURROUNDING GROUNDS: All entry and exit doors have a functional auditory alert. The backyard of the facility has furniture to accommodate the six (6) residents. There is a swimming pool that is fenced all around with a gate that is kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around its parameters.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this Report Issued.
NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Michael Cava
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC809 (FAS) - (06/04)
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