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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610826
Report Date: 11/03/2025
Date Signed: 11/03/2025 01:53:30 PM

Document Has Been Signed on 11/03/2025 01:53 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:G & S ASSISTED LIVINGFACILITY NUMBER:
197610826
ADMINISTRATOR/
DIRECTOR:
MKRTCHAIN, GORFACILITY TYPE:
740
ADDRESS:1235 N. CATALINA STREETTELEPHONE:
(818) 290-1190
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 6CENSUS: 0DATE:
11/03/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Gor MkrtchianTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analysts (LPA) Nadia Shahbazian conducted a Pre-Licensing Inspection and met with Gor Mkrtchian/Administrator at 10:00am. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on May 9, 2025. A fire clearance was approved on June 24, 2025 for six (6) non-ambulatory residents and one (1) bedridden resident, for total capacity of six (6). The applicant has a hospice waiver to retain six (6) residents.

Facility is an one story rental house, in a residential area. The entire house has been completely remodeled, all appliances and furnishings are brand new. The required posting were posted in the dining room, accessible to residents. The smoke alarms and carbon monoxide detectors are dual and inter-connected. At 10:23am, smoke and carbon monoxide detectors were tested and LPA observed two fire doors closing properly. One of the fire doors leads to the hallway and the other one leads to bedroom #3. The facility has a fire extinguisher kept in the kitchen, purchased today on 11/03/2025. Facility has several exit doors throughout the facility, one in the dining room, one in the living room, one in bedroom #1 and one in bedroom # 3. There is a clearly marked exit sign atop the living room exit door. Facility uses the living door room as the main fire exit.

With the assistance of the administrator, a tour of the physical plant was initiated at 11:00am and the following was observed:

Continued on 809-C
NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2025
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: G & S ASSISTED LIVING
FACILITY NUMBER: 197610826
VISIT DATE: 11/03/2025
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KITCHEN: The kitchen is equipped with brand new appliances, including a refrigerator, stove/oven, and dishwasher and water filtering system. Knives were observed locked in a kitchen drawer. There was an adequate supply of non-perishable food items and supply of dishes in kitchen cabinets. Perishable food items are not required at this time, as there are no residents. Administrator was advised that facility needs to carry perishable food items once they admit residents for care. Medications will be kept locked in a kitchen cabinet. There is a complete first aid kit and first aid manual in the kitchen.

COMMON AREAS: The dining room is located next to the kitchen, furnished with a table and six chairs. The living room/family room is a large space and is furnished with a coffee table and a large couch, appropriate for number of the residents. There is a non-operational fireplace in the living room, properly screened, no fireplace tools were present. Games and puzzles are observed in the living room. Facility has internet and wi-fi access for resident's use.

BEDROOMS: There are three (3) shared bedrooms designated for client use. All the bedrooms were furnished with beds, night-stands, chairs, closets and supply of bedding and linens. The bedroom # 3 is designated as bedridden room and it has it's own exit door, leading to the backyard. Bedroom #1 also has an exit door, leading to the side gate.

BATHROOMS: The facility has two (2) full bathrooms, one between bedrooms #1 and #2 and one inside bedroom #3. Both bathrooms were observed to have proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 109.2 and 112.1 degrees Fahrenheit.

LAUNDRY AREA: There is a brand new washer and dryer in the laundry area in the hallway. The laundry and kitchen detergents and chemicals are kept locked in a cabinet, across from the laundry area.

OFFICE AREA: Facility's office is located behind the living room. LPA observed a locked filing cabinet, to maintain all resident and staff records.

SURROUNDING GROUNDS: The passageways and entrance to the home was clear of any obstruction. All entry and exit doors have a functional auditory alerts, when the doors open. The backyard of the facility is large enough to hold outdoor activities. The patio furniture included table, chair and an umbrella. There is no swimming pool or body of water and no garage or drive way.

In addition to the Pre-Licensing inspection, a Component III power point presentation was held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report was provided to the administrator.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
LIC809 (FAS) - (06/04)
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