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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610663
Report Date: 10/17/2025
Date Signed: 10/17/2025 10:55:14 AM

Document Has Been Signed on 10/17/2025 10:55 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:SERENE HAVEN ASSISTED LIVINGFACILITY NUMBER:
197610663
ADMINISTRATOR/
DIRECTOR:		PARYAV, SINTIAFACILITY TYPE:
740
ADDRESS:22445 VANOWEN STTELEPHONE:
(818) 457-0197
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 6CENSUS: 0DATE:
10/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Sintia ParyavTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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At approximately 9:30 a.m. on 10/17/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the licensee and disclosed the reason for the visit. LPA and the licensee toured the facility inside and out.

The facility is a single story building with six (06) bedrooms, three (03) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden in Bedroom #3. The facility plans residents with dementia. Approved hospice waivers for five (05).

The front entrance is gated and unlocked. Fruit bearing trees were observed in the front and back yards. Both yards were maintained. Handrails at the front and rear doorways were secure. A new artificial hedge was installed near the pool. Shaded seating areas were observed at the front and rear of the facility as well. At the front door, LPA observed postings for the facility sketch, administrator certificate, emergency disaster plan, personal rights, theft and loss policy, rights of resident councils, nondiscrimination notice, confidential complaint contacts, and ombudsman contacts.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 10:00 a.m. LPA measured the room temperature to be 75 degrees Fahrenheit. The living room contained a television, reading materials, board games, puzzles, and furniture in good repair. A fireplace was appropriately covered. LPA also observed an office area near the main entrance. At 10:10 a.m. the house telephone was called and deemed operational. At approximately 10:20 a.m. LPA observed a fully charged fire extinguisher in the kitchen. Hallways and resident rooms contained night lights. Hallway closets contained hygiene supplies, paper supplies, and adequate amounts of fresh linens.

NAME OF LICENSING PROGRAM MANAGER: Naira Margaryan
NAME OF LICENSING PROGRAM ANALYST: Nicholas Reed
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2025
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 3
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SERENE HAVEN ASSISTED LIVING
FACILITY NUMBER: 197610663
VISIT DATE: 10/17/2025
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At 10:30 a.m., smoke and carbon monoxide detectors were tested and operational. Smoke detectors are hard-wired and functioned simultaneously.

LPA observed an adequate supply of perishable and non-perishable foods in the refrigerator, freezer, and pantry. The pantry also contained sufficient emergency food and water supplies. Appliances were clean and in good condition. Sharps were locked below the counter top. Cleaning solutions were locked below the sink. Medications and confidential files were locked in a cabinet near the dining area. A washing machine and dryer were located near the kitchen. Both appliances were in working order.

Two (02) out of two (02) exit gates were unlocked. Exit paths were free of debris and tripping hazards. Ramps and hand rails were secure and sturdy. The pool in the back yard was gated, inaccessible, and locked. The garage was locked and contained extra supplies, tools, and an extra refrigerator.

The facility has six (06) bedrooms. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Beds with wheels were locked and secured. Four (04) out of four (04) auditory alarms were tested and functioning.

The facility has three (03) bathrooms. Two (02) bathrooms are private to Bedrooms #3 and #6. The shared bathroom is located near Bedroom #1. All bathrooms contained paper towels, handwashing instruction sign, liquid soap, trash cans with tight fitting lids, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 10:45 a.m. LPA measured the water temperature to be 118.1 degrees Fahrenheit in the shared bathroom nearest the main entrance.

At 11:00 a.m. LPA and the licensee reviewed the Compliance and Regulatory Enforcement (CARE) tools.

Due to the facility having no residents or staff, a file review was not conducted.

During today’s inspection, no immediate health or safety hazards were observed.

Exit interview conducted. Copy of report provided.

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

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC809 (FAS) - (06/04)
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