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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610903
Report Date: 04/27/2026
Date Signed: 04/27/2026 02:41:21 PM

Document Has Been Signed on 04/27/2026 02:41 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:BURBANK PATHWAY VILLAFACILITY NUMBER:
197610903
ADMINISTRATOR/
DIRECTOR:		SARKISYAN, MARGARITFACILITY TYPE:
740
ADDRESS:1029 N BUENA VISTA STREETTELEPHONE:
(818) 480-2844
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 6CENSUS: 0DATE:
04/27/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Margarit Sarkisyan TIME VISIT/
INSPECTION COMPLETED:
02:40 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
Licensing Program Analyst (LPA) Nadia Shahbazian conducted an announced Pre-Licensing Inspection and met with Margarit Sarkisyan -Administrator and Co-Administrator Mariam Harutyunyan. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on August 20, 2025. A fire clearance was approved on December 10, 2025 for six (6) Bedridden resident.

Facility is an one-story house in a residential area, located on a busy street. The house has been completely remodeled, all appliances and furnishings are brand new. The required posting were posted by the entry door, accessible to residents. The smoke alarms and carbon monoxide detectors are dual and inter-connected and there is a fire pull station by the entry door. At 10:12am, smoke and carbon monoxide detectors were tested and observed to be functional. In addition facility is equipped with one fire door in the living room, leading to the hallway. There are fire sprinklers throughout the entire house. The facility has one fire extinguisher in the kitchen, purchased on 11/07/2025.

With the assistance of the administrator, a tour of the physical plant was initiated at 11:40am and the following was observed:

KITCHEN: The kitchen is equipped with brand new appliances, including a refrigerator, stove/oven, microwave and dishwasher. Knives were observed locked in a kitchen drawer. There was an adequate supply of perishable and non-perishable food items and supply of dishes in kitchen cabinets.

COMMON AREAS: The living room is located by the entry and is furnished with a coffee table and couches, appropriate for number of the residents. LPA observed a television set and a cabinet stocked with games and puzzles, in the living room. An open concept dining area is located next to the kitchen. The dining room is furnished with a table and eight chairs. Facility has land-line telephone, internet and cable for resident's use.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2026
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: BURBANK PATHWAY VILLA
FACILITY NUMBER: 197610903
VISIT DATE: 04/27/2026
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
BEDROOMS: There are six (6) private bedrooms designated for resident's use. All the bedrooms were furnished with beds, night-stands, chairs, closets, and supply of bedding and linens. Bedrooms #4, 5 and 6 have exit doors leading to the backyard. All bedrooms have fire sprinklers and smoke/monoxide detectors.

BATHROOMS: There are total of two (2) bathrooms for resident use. One of the bathrooms is located next to bedroom #1 and other is near bedrooms # 4. All resident bathrooms were observed to have proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 115.4.4 and 1115.6 degrees Fahrenheit.

LAUNDRY ROOM: A stackable washer and dryer was observed in the laundry room next to bedroom#2. A locked cabinet is used to store laundry detergents and kitchen chemicals.

MEDICATION CABINET: Medications will be kept locked in a cabinet in the living room. LPA observed a complete first aid kit and first aid manual in the same cabinet.

OFFICE: Office area is located by the entry door. There is 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 exit doors have functional auditory alerts, when opened. In the rear hallway, facility has one exit door, with a ramp, which will be used as the emergency exit. There are two side gates in the front and a gate in the rear alley, which can be used for emergencies. There is a covered shaded area in the backyard with furniture that includes a set of tables, chairs, appropriated for number of residents and staff. There is no swimming pool or body of water. Currently there is no garage, facility will be using the street for parking. The garage used to be in the back but it has been converted to a permitted Accessory Dwelling Unit (ADU). The ADU is separated by a wall and it's completely inaccessible by the facility. The ADU is currently vacant but may be used as a rental property in the future.

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: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Nadia Shahbazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC809 (FAS) - (06/04)
Page: 3 of 3