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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610795
Report Date: 03/23/2026
Date Signed: 03/23/2026 01:21:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/26/2026 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20260226151208
FACILITY NAME:DEVOTED CARE ASSISTED LIVINGFACILITY NUMBER:
197610795
ADMINISTRATOR:MAHMOODZADEH, NIRVANAFACILITY TYPE:
740
ADDRESS:9229 VALJEAN AVETELEPHONE:
(747) 755-2120
CITY:NORTH HILLSSTATE: ZIP CODE:
91343
CAPACITY:6CENSUS: DATE:
03/23/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Nirvana Ghaemi MahmoodzadehTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Unlicensed Care being provided
INVESTIGATION FINDINGS:
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Licensing Program Manager (LPM) Naira Margaryan, Licensing Program Analysts (LPAs) Tihesha Smith and Gary Tan met with Licensees Nirvana Ghaemi Mahmoodzadeh, Noraet Neshan and Licensee applicant Nona Virabyan at the Woodland Hills-South Adult and Senior Care Regional Office to deliver findings.

Unlicensed Care being provided

The Department received information that the home provided care for at least two (2) individuals living in the home without licensure. On 03/04/26 LPAs Tihesha Smith and Abeye Dugma made an unannounced initial 10-day complaint visit but were unable to reach anyone at the home. LPAs spoke with neighbors near home. Neighbors revealed they have seen elderly individuals at the home and access transportation at the home. Subsequent visits were conducted in the morning and afternoon on 03/16/26. Entry into the house was allowed at approximately 3:20 pm.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 31-AS-20260226151208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: DEVOTED CARE ASSISTED LIVING
FACILITY NUMBER: 197610795
VISIT DATE: 03/23/2026
NARRATIVE
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(cont from 9099C)
The home is single story that has two (2) bathrooms and six (6) bedrooms; however, the Los Angeles County Assessor’s website lists the home having four (4) bedrooms and two (2) bathrooms and there is a pending application for licensure on file with CCLD for this location.
LPA Smith conducted tour and observed there were no individuals in the home however at least one or more rooms had clothing, personal items, medication and appeared to be in use but male home guide unable to provide clear information regarding the observation. During follow-up contact via phone, email and in office applicant Nona Virbayan stated had no knowledge of unlicensed operation however, both Nirvana Ghaemi Mahmoodzadeh and Noraet Neshan admitted to providing care and supervision to six (6) individuals in the home.

Based on the information obtained and operator admission it was determined that six (06) out of six (06) individuals residing in the home required and were receiving care and supervision to retain activities of daily living. Care and supervision include and not limited to assistance with medication, bathing and dressing. Therefore, the allegation of "Unlicensed Care" is SUBSTANTIATED at this time.

A Notice of Operation in Violation of Law (NOVL) was issued. The operator was advised that a retroactive civil penalty of $100 per day per tenant shall be assessed on the 15th day from the original date of the Notice of Operation in Violation of the Law (Mar 4, 2026) for the operation of an unlicensed facility. If the operator has not ceased operation or submitted a completed application for licensure within 15 calendar days of the issuance of this notice on the 16th day from the notice, if the unlicensed operation continues to operate, a $200 per resident per day will be assessed until a completed application is submitted or the operation ceases.

The operator may submit an application at the Woodland Hills Adult and Senior Care Regional Office located 21731 Ventura Blvd STE 250, Woodland Hills, 91364. The operator may go to www.ccld.ca.gov for orientation information.

Exit interview conducted/Copy of the report given.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20260226151208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DEVOTED CARE ASSISTED LIVING
FACILITY NUMBER: 197610795
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/23/2026
Section Cited
HSC
1569.44
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§1569.44 Unlicensed residential care facility for the elderly… (a) A facility shall be deemed to be an "unlicensed residential care facility for the elderly" … (1) The facility is providing care and supervision and (3) The facility retains residents who demonstrate the need for care and supervision. This requirement is not met as evidenced by:
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Pending application for licensure is on file.
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Based on operators admission all six individuals are receiving elements of care and supervision, which poses an immediate health and safety risk or personal rights risk to residents in care.
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No individuls requiring care and supervision were in the home during tour of home on 03/16/26, in addition to Administrator provided email on 3/17/26 that all individuals have been relocated and during this office visit licensees/applicant will not have any indviduals in home until licensed.
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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.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3