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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850680
Report Date: 05/22/2026
Date Signed: 05/22/2026 12:42:59 PM

Document Has Been Signed on 05/22/2026 12:42 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ANGELS TOUCH SENIOR LIVINGFACILITY NUMBER:
565850680
ADMINISTRATOR/
DIRECTOR:
NAHAPETYAN, ELLENFACILITY TYPE:
740
ADDRESS:4243 APRICOT ROADTELEPHONE:
(818) 675-0245
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 6CENSUS: 0DATE:
05/22/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Quennie Shaikh / Ellen NahepetyanTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Martha Arroyo conducted a pre-licensing inspection today at 10:00 a.m. Upon arrival, the LPA met with Applicants Quennie Shaikh and Ellen Nahapetyan.

The facility is a single-story home with four (4) bedrooms and two (2) bathrooms. All four (4) bedrooms are designated for residents. The facility fire clearance is approved for five (5) non-ambulatory residents and one (1) bedridden resident totaling six (6) residents. Bedroom #4 is bedridden approved and has a direct exit to the outside. A dementia program was included in the plan of operation.

The LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The combination smoke alarm/carbon monoxide detectors were tested and functioned properly. The LPA observed one (1) fire extinguishers fully charged with attached receipt purchase date 05/21/2026.

A physical plant tour was conducted with the applicants. Facility observed clean and in good repair. Facility temperature is at 68 degrees Fahrenheit. All window screens are clean and in good repair. There is appropriate lighting in the facility and in each room. Indoor and outdoor passageways are free of obstruction. The facility has working auditory alarms on all the exits.

All required postings observed - Facility Theft and Loss Program, Licensing Complaint Poster, Resident Personal Rights, and Resident Council Rights, and Long Term Care Ombudsman poster are posted. Emergency exiting plans and telephone numbers also observed posted.

Report Continued on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Martha Arroyo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2026
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)
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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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ANGELS TOUCH SENIOR LIVING
FACILITY NUMBER: 565850680
VISIT DATE: 05/22/2026
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Report Continued from LIC 809...

Kitchen and dining room floors are clean, sanitary, and odorless. Trash cans have tight fitting covers. Kitchen areas are clean and free of litter, rodents, vermin and insects. There are no pesticides, poisons, or other toxic substances stored in any food storage or preparation area or with utensils. Cleaning supplies are kept in areas separate from food supplies. Cleaning supplies are locked and inaccessible under the kitchen sink. There is a separate food pantry closet for all food supplies. A seven (7) day supply of non-perishable food is present. There are sufficient amounts of tableware, tables, dishes, and utensils. There are sufficient amounts of equipment for the storage, preparation, and service of food. All equipment and dishes observed clean and in good repair. There is a dining area convenient to the kitchen with appropriate dining furniture sufficient for all six (6) residents. The hot water temperature was measured in the kitchen sink, and it measured at 117 degrees Fahrenheit at the time of the visit.

Four (4) resident bedrooms observed large enough to allow for easy passage between and comfortable usage of beds and other required items of furniture, and any resident assistant devices such as wheelchairs or walkers. There is a bed for each resident equipped with good springs, clean and mattress, pillow(s), and bedding. There is a chair, nightstand, chest of drawers, sufficient lighting and lamp for each resident. There is sufficient closet and drawer space for each resident. There is a sufficient supply of clean linen, including blankets, bedspreads, top sheets, bottom sheets, pillowcases, and mattress pads. No bedroom was used as a passageway to another room, bath or toilet. No staff bedroom on premises. For Nocturnal Shift, there will be awake night staff only.

Bathroom floors are clean, sanitary, and odorless. The hot water temperature is between 105-120 degrees Fahrenheit. All showers and toilets have grab bars. All showers have non-skid mats. All fixtures operate properly. Night lights are present in hallways and bathrooms. There is a sufficient supply of hygiene items such as soap, paper towels, toilet paper, bath towels, hand towels, and wash cloths. Personal hygiene items will be kept locked under the bathroom sink.

Medications will be kept in a locked closet adjacent to the kitchen. There is a first aid kit, including sterile dressings, bandages, thermometer, scissors, tweezers, and a current first aid manual. Resident and staff records are to be stored inaccessible in a cabinet adjacent to the living room.

Report Continued on LIC 809C...

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Martha Arroyo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ANGELS TOUCH SENIOR LIVING
FACILITY NUMBER: 565850680
VISIT DATE: 05/22/2026
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Report Continued from LIC 809C...

The common areas were appropriately furnished, and the lighting was adequate. There are games and/or activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. There is a fireplace in the living room adequately screened. There is an attached garage that is only accessible from the exterior of the home. Garage will be used for storage and kept locked at all times.

Laundry closet observed with washer and dryer, sufficient locked storage space for detergents and other hazardous supplies. Laundry closet doors will be locked and inaccessible at all times.

There is a covered patio area in the rear of the home with appropriate furniture for outdoor use. The outside area was observed to be large enough to conduct outdoor activities. A locked shed used for storage purposes was observed locked at the time of the visit. The LPA observed two (2) side gates with latching mechanism. The exterior passageways were clean and clear of any obstructions. There were no bodies of water observed at this time.

Physical plant is consistent with the submitted facility sketch/floor plan.

Applicants completed the Component III Orientation during the visit.

No corrections required at this time.

This report will be provided to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview conducted. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Martha Arroyo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026
LIC809 (FAS) - (06/04)
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