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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610867
Report Date: 12/08/2025
Date Signed: 12/08/2025 04:13:48 PM

Document Has Been Signed on 12/08/2025 04:13 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:ASE BLESSED COMFORT HOMEFACILITY NUMBER:
197610867
ADMINISTRATOR/
DIRECTOR:		PARSADANYAN, EVELINA EDIKIFACILITY TYPE:
740
ADDRESS:9560 LEV AVETELEPHONE:
(818) 739-2556
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 6CENSUS: 0DATE:
12/08/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator - Evelina ParsadanyanTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Nadia Shahbazian conducted a Pre-Licensing Inspection and met with the Administrator Evelina Parsadanyan. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on July 23, 2025. A fire clearance was approved on October 17, 2025 for six (6) non-ambulatory residents and one (1) bedridden resident in bedroom #4, facility has an approved hospice waiver to retain five (5) hospice residents.

Facility is a one-story home in a residential area. The home is completely remodeled and consists of four (4) bedrooms, three (3) bathrooms, dining room and living room and a detached garage.

With the assistance of the administrator, a tour of the physical plant was initiated at 2:25PM, and the following was observed:

The required postings were observed in the hallway and office area, accessible to residents. The smoke and carbon monoxide detectors are dual and inter-connected. At 2:35PM, smoke/carbon monoxide detectors were tested and observed to be functional. Facility is equipped with three fire doors, one leading to bedrooms #1 and # 2, one leading to bedroom #4 and one near the living room hallway. The facility has a brand new fire extinguisher in the kitchen, purchased on 08/13/2025.

KITCHEN: The kitchen is located across the entry door. Kitchen is equipped with brand new appliances, including a refrigerator, stove/oven, dishwasher and two microwave ovens. There was an adequate supply of non-perishable food items and supply of dishes/utensils 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. Knives were observed locked in a kitchen drawer. Cleaning supplies were observed locked underneath the kitchen sink.

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NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2025
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: ASE BLESSED COMFORT HOME
FACILITY NUMBER: 197610867
VISIT DATE: 12/08/2025
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COMMON AREAS: The dining room is located near the kitchen and has a table large enough to seat six (6) residents. The living room is located near the office and is furnished with couches, table, television and a cabinet containing games and art/craft items. There are storages near dining room, living room and hallways. One of the storages in the hallway is used for storing extra food supplies and one is used for the electrical/cable equipment. Facility has a camera (with no sound) in common areas and offers land-line, cable and wi-fi access to residents.

BEDROOMS: There are four (4) bedrooms designated for client use. Bedrooms #1 and #2 are located in the front and bedrooms #3 and #4 are located in the back of the house. Berdooms #1 and # 2 are private. All the bedrooms were furnished with beds, night-stands, chairs, closets, television sets, ceiling fans and supply of bedding and linens. The bedroom # 4 is designated as the bedridden room and it has it's own exit door. Bedroom #2 also has it's exit door.

BATHROOMS: The facility has three (3) bathrooms, one of the bathrooms is located near the office and is designated for the staff use. There is a full bathroom across from bedroom #3 and one full bedroom near bardoom #1. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 107.1 and 109.0 degrees Fahrenheit.

LAUNDRY ROOM: The laundry room is located in the hallway next to living room and will be kept locked, inaccessible to residents. LPA observed a brand new the stacked washer/dryer. The laundry chemicals and detergents were observed in a locked cabinet.

OFFICE: A hallway next to the kitchen leads to the office. There are locked cabinets in the office to be used for confidential residents and staff files.

MEDICATIONS: Medications will be kept locked in a cabinet near the office. There is a complete first aid kit and first aid manual in the medication cabinet.

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

DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025
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: ASE BLESSED COMFORT HOME
FACILITY NUMBER: 197610867
VISIT DATE: 12/08/2025
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SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have functional auditory alerts, when the doors open. The backyard of the facility is large enough to hold outdoor activities. LPA observed two sets of patio furniture, set inside two separate covered patios. There is no swimming pool or body of water. There is a locked shed in the backyard, used to store additional supplies. There are two side gates and four exit doors (including the front door). There is an exit door in bedroom #4, one in bedroom#2 and one in living room. The living room exist leads to the backyard, the facility will be using the living room exit as the main emergency exit. The one car garage is detached and is located in the front of the house. LPA observed emergency water and supplies in the garage.

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 provided.

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

DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2025
LIC809 (FAS) - (06/04)
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