197610929-5-1-2026-31-AS-MAGN-DTNTKD-20260501144747

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610929
Report Date: 05/01/2026
Date Signed: 05/01/2026 02:52:21 PM

Document Has Been Signed on 05/01/2026 02:52 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:	FOREVER YOUNG SENIOR CARE INC		FACILITY NUMBER:	197610929
ADMINISTRATOR/ DIRECTOR:	ALADADYAN, YELENA		FACILITY TYPE:	740
ADDRESS:	9501 SHOSHONE AVE		TELEPHONE:	(818) 207-4220
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 6		CENSUS: 0	DATE:	05/01/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Yelna Aladayan- Licensee		TIME VISIT/ INSPECTION COMPLETED:	12:30 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	Licensing Program Analyst (LPA) Mariana Agban conducted a Pre-Licensing Inspection with the facility Licensee Yelna Aladayan. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 09/03/2025. A fire clearance was approved on 10/28/2025 for a maximum capacity of five (5) non-ambulatory residents, and one(1) Bedridden resident. A hospice waiver has been requested for 6 residents and is pending approval from the manager. A tour of the physical plant inside and out was conducted at approximately 09:05 a.m., and the following were observed: Common Areas: These included the dining area and the living area. The common areas were checked for cleanliness, and furniture was checked for functionality. All areas were clean and sanitary, and the furniture was in good repair. LPA observed board games and sufficient space for activities. Dining table and couches sit the capacity of the facility. The facility was kept at a comfortable temperature. There is a fireplace in the living room that is properly screened. The fireplace is non-functional. No key to the fireplace, and fireplace tools were not present. Bedrooms: LPA inspected five (5) residents' bedrooms. LPA observed bedrooms to be properly furnished and had adequate lighting. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress covers, and blankets. Bedrooms #1,#2,#3, and #4 are approved for Non-ambulatory residents. Bedroom#5 is approved for one (1) Bedridden resident. LPA observed a fireplace in bedroom#5 and Bedroom#4, which were non-functional. (Continue on 809 C)

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Mariana Agban
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/01/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

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: FOREVER YOUNG SENIOR CARE INC	FACILITY NUMBER: 197610929
	VISIT DATE: 05/01/2026

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Bathrooms: The facility has (2.5) bathrooms. Bathroom#1 is located in the main hallway, as well as a half bath. LPA observed bedroom#4 has a private bathroom. All bathrooms are clean, properly supplied with toilet paper, hand soap, paper towels, and trash bins with lids. LPA observed bathrooms had functional fixtures. Hot water temperature was measured from the bathroom sink at 108.6 and 111.5 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection.

Smoke detectors and Carbon Monoxide detectors were tested and observed to be functioning properly. The fire extinguisher was observed to be fully charged and purchased on 10/23/2025.

Kitchen: The kitchen appliances and fixtures appeared functional. LPA observed the refrigerator and freezer at proper temperatures. There was a sufficient amount of non-perishable foods properly stored in the kitchen cabinets. Knives and sharp objects are locked in the kitchen drawers. LPA observed the office/workstation area by the kitchen. Residents' and Staff files will be kept locked in the office cabinet. The facility has a functioning telephone that is located in the office. There is also a complete first aid kit with an up-to-date manual.

Medications: LPA was informed that medications will be kept in the medication closet in the main hallway.

Laundry Room: LPA observed the laundry room to be locked, and the laundry toxins are locked in the laundry cabinets.

Garage: LPA observed the garage to be used only as storage. No hazards observed.

Surrounding Grounds: The driveway, passageways, and entrance to the home were clear of obstruction. . There was furniture appropriate for outdoor use. The outdoor area was free of hazards. There are no bodies of water on the premises. LPA observed the outdoor kitchen and the Buda Statue in the backyard.

Component III was conducted on-site with Licensee Yelena Aladadyan

Pursuant to Title 22, Division 6, the facility was observed to be compliant with the regulation. Pre-Licensing is complete, and this facility has no deficiencies observed. A copy of this report will be forwarded to the application specialist. Exit interview conducted, report signed and issued.

NAME OF LICENSING PROGRAM MANAGER: Mary G Flores
NAME OF LICENSING PROGRAM ANALYST: Mariana Agban
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/01/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC809 (FAS) - (06/04)

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