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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610941
Report Date: 04/06/2026
Date Signed: 04/06/2026 01:06:37 PM

Document Has Been Signed on 04/06/2026 01:06 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:GLENDALE HERITAGE HOMEFACILITY NUMBER:
197610941
ADMINISTRATOR/
DIRECTOR:		SIRUNYAN, HOVHANNESFACILITY TYPE:
740
ADDRESS:2216 E GLENOAKS BLVDTELEPHONE:
(818) 856-9571
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY: 6CENSUS: 0DATE:
04/06/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:HOVHANNES SIRUNYAN, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On 04/06/26, at 10:15am, Licensing Program Analyst Gina Saucedo conducted an announced Pre-licensing visit. LPA met with HOVHANNES SIRUNYAN, Administrator.

An application was submitted to Community Care Licensing Division-CCLD on 10/2025, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The requested capacity is for six (6) non-ambulatory and the fire clearance was approved on 11/2025.

Structure: This is a one-story single-facility with four (4) bedrooms and two (2) bathrooms and a backyard.

Entrance: There is only one (1) entrance being utilized. Required postings such as: YES sign posted, Ombudsman sign, House Rules, Resident Council, Personal Rights and Administration Certificate against the wall of the facility on your left hand side.

Toxins, cleaning solutions, and laundry detergents will be kept locked in a cabinet under the kitchen sink.

Living/Dining area: The living room is neat, clean, and organized with sufficient seating for both residents and staff. Both areas are properly furnished and in good repair. The facility maintains a comfortable temperature between seventy (70) and seventy-one (71) degrees. No firearms observed or will be maintained on the premises. There is a working telephone on the premises.

LIC809C-continued

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2026
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: GLENDALE HERITAGE HOME
FACILITY NUMBER: 197610941
VISIT DATE: 04/06/2026
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Resident/staff files: Resident and staff files will be kept locked in a filing cabinet in the office area. The office area is not part of the facility. LPA was still able to tour it.

Kitchen: Sufficient supplies of dishes, cups, and silverware located within the kitchen cabinets and drawers. Sharps are stored on the left side of the kitchen locked and inaccessible to the residents. Kitchen appliances are working and are in good repair.

Emergency: Fire extinguisher located in the entrance of the facility and dated 09/2025.

Medications: The medication is currently kept in a top cabinet in the kitchen area locked and inaccessible to the current residents. First-aid kit will also be kept in this area.

Bedrooms: The bedrooms are properly furnished with bed, nightstand, applicable lightening, and seating. Window coverings are in good repair, not broken or damaged. There are four (4) bedrooms-two (2) shared and two (2) single occupied.

Bathroom: There are two (2) bathrooms are in proper condition and will be equipped with sufficient personal hygiene for each resident.

Hallways: Hallway is properly lighted. The washer and dryer is located towards the back of the facility.

Staff room: there is no designated staff room in the facility at this time.

Water Temperature: The water temperature was measured in the bathrooms between 113.5 and 114.1 Fahrenheit and is within regulations.

There are cameras in common areas and the facility has a signal system.

LIC809C-continued

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
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: GLENDALE HERITAGE HOME
FACILITY NUMBER: 197610941
VISIT DATE: 04/06/2026
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Smoke detectors: Dual interconnected smoke detectors and carbon monoxide observed to be working properly and were tested.

Garage: There is a no garage.

Outside: There is a shaded area for residents.



Pool: No bodies of water located at the facility.

Administration: The facility had submitted an Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan.

The Component III Orientation RCFE-Residential Care Facilities Elderly was shown/reviewed with the Administrator.

Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved.

Exit interview conducted and copy of this report issued to the administrator.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
LIC809 (FAS) - (06/04)
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