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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610697
Report Date: 01/20/2026
Date Signed: 01/20/2026 03:22:32 PM

Document Has Been Signed on 01/20/2026 03:22 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:COMFORT COVE SENIOR LIVINGFACILITY NUMBER:
197610697
ADMINISTRATOR/
DIRECTOR:		HASMIK ANDREASYANFACILITY TYPE:
740
ADDRESS:6856 HESPERIA AVETELEPHONE:
(626) 616-2024
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: 1DATE:
01/20/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Irma Chavezdefranco, StaffTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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At 12:30 PM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual Inspection visit to the above listed facility. LPA met with the staff Irma Chavezdefranco and the staff contacted the consultant, Victoria Hayratepyan who informed LPA that the facility is currently in the process of change of ownership. LPA explained the reason for the visit and LPA was informed that the current owner/Administrator will be informed to conduct today's annual inspection. LPA contacted the Administrator via telephone and explained the reason for the visit. LPA was informed that the Administrator is unable to come and also does not have a designee to conduct today's visit. LPA and staff conducted the physical plant tour of the facility and observed the following:

KITCHEN: The kitchen is equipped with a refrigerator, microwave, stove/oven and dishwasher. LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). LPA observed two knives on the kitchen counter unlocked and accessible to one (1) resident in care. LPA also observed a pair of scissors on a magnet holder on the fridge in the kitchen unlocked and accessible. An additional knife was observed in the kitchen drawer locked; however, the magnetic key was observed accessible on the fridge in the kitchen. LPA observed that all cleaning supplies unlocked under the sink cabinet in the kitchen. LPA observed a Fire Extinguisher and was last purchased on 12/001/2025. It was observed hanging on the wall in the kitchen.

MEDICATION ROOM: LPA observed centrally stored medication locked standing cabinet in the kitchen. Residents and staff files were observed locked in the living room.
Continue on LIC 809C
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Huma Rahimi
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2026
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 8
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: COMFORT COVE SENIOR LIVING
FACILITY NUMBER: 197610697
VISIT DATE: 01/20/2026
NARRATIVE
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BEDROOMS: There are total of five (5) bedrooms of which bedroom #4 will be used for staff. The facility also has an extra space for an office. Four (4) bedrooms are designated for resident’s use. Bedrooms number three (3) and five (5) are shared. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. The facility has a live-in staff.

BATHROOMS: There are three (3) bathrooms at the facility. LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 118.2°.

LAUNDRY ROOM: The laundry room is located in the kitchen knot area. LPA observed all laundry detergents unlocked in a cabinet next to the washer and dryer. The washer/dryer appear to be in good working condition.

COMMON AREAS: The facility maintains a comfortable temperature at 73°F. The living room and dining area
appeared clean and were properly furnished and has a television. No obstructions and or tripping hazards throughout the facility. LPA observed a working telephone for the facility.

SURROUNDING GROUNDS: The facility has sufficient backyard space. LPA did observe appropriate outdoor furniture in the backyard of the facility that can accommodate six (6) residents, LPA observe a covered shaded area for residents. There is no swimming pool or any bodies of water at the facility. The exit was free of any obstruction or hazard.

Garage/Storage: LPA observed two (2) storage areas and both were locked and inaccessible. The garage will be used as a storage for extra supplies and will be kept locked.

Continue on LIC 809C
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Huma Rahimi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/20/2026 03:22 PM - It Cannot Be Edited


Created By: Huma Rahimi On 01/20/2026 at 02:16 PM
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: COMFORT COVE SENIOR LIVING
FACILITY NUMBER: 197610697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in having all cleaning solutions, sharp objects unlocked and accessible to a resident in care which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/22/2026
Plan of Correction
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The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87309 Storage Space; The written letter must be sent to the LPA by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Huma Rahimi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2026


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 01/20/2026 03:22 PM - It Cannot Be Edited


Created By: Huma Rahimi On 01/20/2026 at 02:16 PM
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: COMFORT COVE SENIOR LIVING
FACILITY NUMBER: 197610697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.618(c)(3)
Other Provisions
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in having one staff without CPR/first aid training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2026
Plan of Correction
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The Administrator agreed to provide one (1) staff CPR/first aid training by POC due date.
Type B
Section Cited
HSC
1569.618(a)
Other Provisions
(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in not being available themselves or a designee at the facility during normal business hours which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2026
Plan of Correction
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The Administrator will submit an updated LIC 500 with their working hours at the facility and have a designee for the facility during their absence with their contact information to LPA by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Huma Rahimi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2026


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 01/20/2026 03:22 PM - It Cannot Be Edited


Created By: Huma Rahimi On 01/20/2026 at 02:16 PM
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: COMFORT COVE SENIOR LIVING
FACILITY NUMBER: 197610697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in not maintaining one (1) staff records/file at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2026
Plan of Correction
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The Administrator agreed to have all staff complete files/records available at the facility at all the times for audit and review. The Administrator will submit staff files via e-mail to LPA by POC due date.
Type B
Section Cited
HSC
1569.267(d)
Resident's Bill of Rights
(d) The licensee shall provide initial and ongoing training for all members of its staff to ensure that residents’ rights are fully respected and implemented.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation during today's visit, the licensee did not comply with the section cited above in not properly training the staff who got verbally involved with one (1) resident in an argument which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2026
Plan of Correction
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The Administrator agreed to provide training to all staff on residents' personal rights and submit the training log to the LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Huma Rahimi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2026


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 01/20/2026 03:22 PM - It Cannot Be Edited


Created By: Huma Rahimi On 01/20/2026 at 02:17 PM
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: COMFORT COVE SENIOR LIVING
FACILITY NUMBER: 197610697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87506(b)
Resident Records
(b) Each resident's record shall contain at least the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in not having one (1) resident records/file in the facility for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/27/2026
Plan of Correction
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The Administrator agreed to provide one (1) resident complete file to LPA by POC due date.
Type B
Section Cited
CCR
87411(d)(3)
87411-Personnel Requirements - General(d) All personnel shall be given on the job training or have........effective job performance:(3) Skill and knowledge required to..care and supervision, including the ability to communicate with residents.
This was not met as evidence by:


Deficient Practice Statement
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Based on the interview, the administrator did not have staff available to communicate in English with residents in care which poses a potential risk to the residents in care.
POC Due Date: 01/27/2026
Plan of Correction
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Administrator agrees to put in writing their plan for hiring or ensuring English Speaking staff are always on shift and submit the plan by the POC date. Additionally, Administrator shall submit an updated LIC500 to reflect all staff.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Huma Rahimi
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2026


LIC809 (FAS) - (06/04)
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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: COMFORT COVE SENIOR LIVING
FACILITY NUMBER: 197610697
VISIT DATE: 01/20/2026
NARRATIVE
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SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. They were tested and observed to be operational.

Upon request of one (1) resident and one (1) staff facility files/records, the Administrator informed LPA that no files are available for review/audit. LPA was not provided with any facility files for one (1) resident and one (1) staff.

Additionally, during today's visit, LPA observed that the staff engaged in a verbal argument with one (1) resident. The resident informed LPA that they are having communication issues for their care needs with the staff due to the language barrier; therefore, the staff retaliated of why the resident informed LPA of the issue and it was escalated to a verbal argument between the staff and the resident.

Administrative: LPA collected Certificate of Liability Insurance, and LIC500.

Deficiencies issued during today's visit. Appeal rights explained and exit interview conducted. Copy of this report signed and delivered.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Huma Rahimi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026
LIC809 (FAS) - (06/04)
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