<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610824
Report Date: 10/20/2025
Date Signed: 10/20/2025 01:32:00 PM

Document Has Been Signed on 10/20/2025 01:32 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:LARRABEE ASSISTED LIVINGFACILITY NUMBER:
197610824
ADMINISTRATOR/
DIRECTOR:		MAMYAN, NARINEFACILITY TYPE:
740
ADDRESS:825 LARRABEE STREETTELEPHONE:
(818) 641-9222
CITY:WEST HOLLYWOODSTATE: CAZIP CODE:
90069
CAPACITY: 6CENSUS: 0DATE:
10/20/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Narine MamyanTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/20/25, 10:50 am, Licensing Program Analyst (LPA) Raymond Comer, conducted a scheduled pre-licensing inspection of the Facility. LPA met with Administrator, Narine Mamyan.

Facility is licensed as a single-story building with resident bedrooms, three private bathrooms, and two public bathrooms. A fire clearance approved, dated 09/16/25, for six (6) non-ambulatory residents, all of which may be bedridden. All exits contain delayed egress alarms and were observed working properly.

The purpose of today’s visit was to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6. Component III was conducted with the applicant from 11:30 am 12:00 am.

LPA toured the physical plant with the Administrator and observed the following:

KITCHEN - LPA observed kitchen appliances, (Refrigerator, stove, microwave, etc) working properly. Knives and sharps were observed as stored in an overhead cabinet; locked and inaccessible to residents. Detergents and cleaning agents were observed as stored in lower cabinet underneath the large sink and inaccessible to residents.

[LIC 809C]- Continued
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2025
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)
Page: 2 of 3
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: LARRABEE ASSISTED LIVING
FACILITY NUMBER: 197610824
VISIT DATE: 10/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
COMMONS- Living room, was appropriately furnished with adequate lighting. Dining room was furnished with large table and sufficient amount of chairs for residents and staff; All furnishings in the common areas were observed as being in good condition. Internet service is available and a functioning telephone was on the premises. Multiple closets were observed containing fresh linens and towels for residents.

FIRE SAFETY- Facility is equipped with sprinkler system. Multiple smoke and carbon monoxide alarms are installed, hardwired, and interconnected throughout the Facility; alarms were tested and found as working properly. One (1) Fire extinguisher was observed hanging on dining room wall; purchase date: 7/16/25. Evacuation routes are clearly labelled and posted throughout the facility.

BEDROOMS – All bedrooms contained bed, linens, night stand, chest of drawers, a chair, trash can with a lid, and closet space. All bedrooms have a direct emergency exit.



BATHROOMS- All bathrooms contained hand soap, slip resistant floor mats, grab bars and a trash can. Water was measured at 110.2 degrees F; within the required temperature range.

MEDICATIONS- Mediations will be stored in locked cabinets located on in the office area, adjacent to the living room; medication cabinets are inaccessible to residents. First aid kit was observed as fully stocked with required supplies.

RECORDS- Staff and resident records will be stored in locked cabinets located on in the office area, adjacent to the living room; records cabinets are inaccessible to residents.

LAUNDRY – Laundry room is located across from bedroom# 6; locked and inaccessible to residents. Laundry room contained a clothes washer, dryer, towels, and other supplies for resident needs.

OUTDOORS- Backyard area has a shaded area with a table and chairs sufficient for residents and staff. The gate leading from the back yard to the front yard was not locked.

Exit interview was conducted and a copy provided to Administrator. This report will be forwarded to the Centralized Application Bureau (CAB). Licensee will be notified by the CAB Analyst when facility license has been approved.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3