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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610976
Report Date: 02/23/2026
Date Signed: 02/23/2026 01:20:07 PM

Document Has Been Signed on 02/23/2026 01:20 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:AV ASSISTED LIVINGFACILITY NUMBER:
197610976
ADMINISTRATOR/
DIRECTOR:		MIRZAKHANIAN, ARIGAFACILITY TYPE:
740
ADDRESS:10252 E AVE STELEPHONE:
(818) 469-2001
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY: 20CENSUS: 0DATE:
02/23/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Ariga Mirzakhanian- AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:40 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
On 2/23/2026, at approximately 09:45 AM, Licensing Program Analyst (LPA) Angelica Segovia and Policy Manager (Supervisor I) Carly Hansford conducted an announced Pre-licensing visit. LPA Segovia met with Administrator Ariga Mirzakhanian and Licensee, Arlen Shahverdian.

An application was submitted to Community Care Licensing Division-CCLD on 11/18/2025, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The requested capacity is for twenty (20) non-ambulatory residents of which two (2) may be bedridden. The fire clearance was approved on 1/27/2026.

A physical plant tour was conducted and the following was noted:

Structure: The facility is a two-story building with ten (10) bedrooms and five (5) bathrooms. One (1) room, located on the second floor, is a designated staff room with its own bathroom.

Entrance: There is one (1) main entrance/exit being utilized. Required postings such as: See/Say Something and Long-Term care Ombudsman were observed immediately upon entrance.

Common Areas: These include both living room and dining room. All common areas were observed to be neat, clean and organized. All common areas were properly furnished and in good repair. The facility maintains a comfortable temperature of seventy-one (71) degrees. No firearms observed or will be maintained on the premises.

Residents/staff files: The resident and staff files will be kept in locked staff room inaccessible to residents.

LIC809C-continued

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Angelica Segovia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2026
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 4
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 4
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: AV ASSISTED LIVING
FACILITY NUMBER: 197610976
VISIT DATE: 02/23/2026
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
Kitchen: Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods will be purchased prior to residents’ arrival. LPA observed sufficient supplies of dishes, cups and silverware readily available for the residents upon arrival. Working stove and refrigerator observed and in proper condition. The Sharps/Knives will be stored in a locked kitchen drawer. The toxins/Cleaning solutions will be kept locked in various kitchen storage cabinets and inaccessible to residents.

Medications: The medications will be stored in a locked storage cabinet located near the kitchen. Medication storage is equipped with a lock to ensure medications will not be accessible to residents. First-aid kit observed as well.

Emergency: The Fire extinguishers were observed to be located throughout the facility. LPA observed the fire extinguishers to have been inspected, fully charged and dated 1/10/2026.

Bedrooms: All ten (10) designated resident bedrooms were observed to be properly furnished with bed, nightstand, applicable lightening and seating. LPA observed auditory alarms within each bedroom to be in proper and working condition.

Bathroom: The bathrooms will be maintained in proper condition. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition.

Hallways: Hallway is properly lighted. Extra linens/covers will be stored in storage cabinets.

Laundry Room: The laundry room is located within the hallway’s passageway leading towards bedrooms #1 to #7. All cleaning solutions and toxins will be kept stored in locked cabinets inside the laundry room. Dryer and washer observed to be in proper condition.

The Garage: LPA observed there to be no garage located within the premises.

Staff room: The staff room will be kept locked and inaccessible to residents.

Water Temperature: The water temperature was measured within regulations.

LIC809C-continued

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Angelica Segovia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: AV ASSISTED LIVING
FACILITY NUMBER: 197610976
VISIT DATE: 02/23/2026
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
Smoke detectors: Dual interconnected smoke detectors and carbon monoxide observed to be working properly and were tested.

Outside: The outside is clean, free of hazards, and properly furnished with sufficient seating. A shaded area for residents was observed as well. LPA observed a locked storage unit.



Pool: No body of water located on premises.

Administration: The facility has submitted an Emergency and Disaster Plan for Residential Care Facilities for the Elderly.

The Component III Orientation Residential Care Facility for the Elderly (RCFE) was waived due to the Administrator’s qualifications.

The facility is not yet in compliance with Title 22 Regulations at this time. The Administrator will work on the following and submit corrections to CCLD prior to approval:

-Inclusion of Facility’s Program Design and Admission Agreement to reflect the use of video surveillance with no auditory use in the common areas (hallways, exterior of facility and so forth).

-Bedroom locks on all ten (10) bedrooms will be fixed or removed to ensure residents’ rights are not infringed upon.

-Replacement of all bedroom window coverings/screens.

-One (1) of the five (5) restrooms located between room #8 and #9 will need to have completion of the shower and bathroom sink installed and in proper working condition.

Once completed, 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 was conducted and copy of this report issued to the licensee.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Angelica Segovia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026
LIC809 (FAS) - (06/04)
Page: 4 of 4