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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610836
Report Date: 09/12/2025
Date Signed: 09/12/2025 02:58:30 PM

Document Has Been Signed on 09/12/2025 02:58 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:OAKDALE GARDENS ASSISTED LIVINGFACILITY NUMBER:
197610836
ADMINISTRATOR/
DIRECTOR:		ZHIGOYAN, MARINAFACILITY TYPE:
740
ADDRESS:7445 OAKDALE AVETELEPHONE:
(213) 476-2354
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 6CENSUS: 0DATE:
09/12/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Zhigoyan Marina - AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 9/12/2025 at 1:30PM Licensing Program Analyst (LPA), Perchui Milena Khurshudyan conducted an announced Pre-Licensing visit to the above facility and met with facility Licensee/Administrator Zhigoyan Marina. LPA introduced herself by showing the department badge.

Fire Clearance was approved on 6/10/2025 for a maximum capacity of six (6) Non-ambulatory residents, of which one (1) Bedridden resident for bedroom #3. Facility has a Dementia Care Program. The facility also has Hospice waiver for six (6) residents. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22. The facility is a single-story building. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following:

KITCHEN: The facility has an open floor kitchen area that is equipped with a new refrigerator, microwave oven and sink.

At 2:00pm, LPA observed adequate supplies of nonperishable food properly stored in the cabinets and inside the supply room. Perishable food items are not required at this time as there are no residents in the facility. LPA observed dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked inside a kitchen cabinet and inaccessible to residents in care. The facility has one (1) new fire extinguisher, appeared to be full and serviced and were last purchased on 6/13/2025.

BEDROOMS: There are four (4) bedrooms in the facility and all bedrooms are designated for residents’ use. All bedrooms observed to be furnished with beds, dressers, chairs, night stands and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational at 2:15pm. Facility will have awake staff at night. Emergency call buttons will be provided to residents.

Continue on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2025
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: OAKDALE GARDENS ASSISTED LIVING
FACILITY NUMBER: 197610836
VISIT DATE: 09/12/2025
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LAUNDRY ROOM: The laundry room is located in a separate area /closet next to the dining area. The washer/dryer appears to be new and in good condition. Laundry supplies along with other chemical items will be kept locked inside the cabinets and under supervision when not in use.

BATHROOMS: The facility has four (4) bathrooms. At 1:45PM LPA observed all bathrooms are clean, in good repair and properly supplied with toilet paper, soap and paper towels. LPA observed appropriate grab bars and non-skid mats in all bathrooms. Trash cans had closed tight fitting lids throughout the facility. Water temperature was within regulation, and it was measured by an LPA at 10:55AM to be at 116°F degrees. All bathrooms are designated for Staff and residents’ use.

COMMON AREAS: The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. The facility has activity puzzles, coloring books, crayons, board games and other activity supplies available for residents. No obstructions or tripping hazards throughout the facility. An emergency exit plan/sketch is posted along the hallway with other posting requirements. No fire-arms observed or will be maintained on the premises.

MEDICATION ROOM: The medication will be centrally stored inside the locket cabinet located in the common area next to the kitchen. Facility staff/resident files will be kept centrally stored and locked inside the commercial cabinet located in the office room. First-aid kit was checked to be complete and has the new manual available. The facility will have two (2) staff members for each shift (AM and PM).

SMOKE DETECTORS/CARBON MONOXIDE. Dual smoke detectors and carbon monoxide throughout the facility. At 2:30 PM they were tested and observed to be operational.

SURROUNDING GROUNDS: The facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The backyard is fenced. There is no garage on the property. LPA observed the resin storage shed placed in the backyard. LPA discussed the importance of maintaining care and supervision to meet the needs of the residents. The facility has land line, checked by an LPA to be operational.

Component III was conducted with the Administrator.Based on inspection and observation, the physical plant is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and the applicant will be notified by the CAB Analyst when the license has been approved.

Exit interview was conducted and a copy of this report was provided to the Applicant/Administrator.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC809 (FAS) - (06/04)
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