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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850278
Report Date: 09/24/2026
Date Signed: 09/29/2026 12:25:52 AM

Document Has Been Signed on 09/29/2026 12:25 AM - 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:LOVE IS USFACILITY NUMBER:
195850278
ADMINISTRATOR/
DIRECTOR:		GHAZARYAN, ANIFACILITY TYPE:
740
ADDRESS:7063 TYRONE AVETELEPHONE:
(818) 510-0097
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 6CENSUS: 6DATE:
09/24/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:57 AM
MET WITH:Ani Ghazaryan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
08:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced Annual Inspection and used the complete CARE Inspection Tool to conduct the visit. LPA Yee was let into the home by Debbie Neria, staff. The Administrator was contacted by staff and she arrived at 11:38am to conduct the visit.

The facility is a single storey ADU located in the back of the property. The home consists of a living room, dining room, a kitchen, 3 resident bedrooms with their own private bathrooms and a common powder room. Also located at the end of the hallway is the laundry closet with a washer and dryer. The back house and the front house have a separate addresses and are separated by a solid fence. However, there is a back gate that permits staff from both homes entry to both homes. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN resident.

On today's visit, all 12 domains of the CARE Inspection Tool was reviewed. Also reviewed were 6 resident files, 4 staff files and the Emergency and Disaster Plan. The following was observed during today's visit:
  • the living room, dining room and kitchen are equipped and furnished with the appropriate furniture and equipment for its designated use.
  • all resident rooms are shared rooms and each are furnished with 2 hospital beds, night stand, 2 dressers, a built in closet. No chairs or lamps were observed. Per explanation provided, the residents don't want the lamps and the chairs were stored away due to residents climbing on the chairs.
  • the beds were observed with a mattress cover, a fitted sheet and a blanket. There were no flat sheets or comforters observed on the beds. Per explanation provided, the residents do not like flat sheets and the comforters are in the closet due to the hot weather.
continued on LIC809-C
Kristin Heffernan
Christine Yee
DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2026
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 8
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LOVE IS US
FACILITY NUMBER: 195850278
VISIT DATE: 09/24/2026
NARRATIVE
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  • located inside the resident rooms are private bathrooms equipped with a shower stall, a toilet and a vanity with a single sink. Grab bars, shower chairs and a slip resistant mat was observed. The water temperature taken in Bedroom #1 read 112.5, Bedroom #2 read 119.0 and Bedroom #3 read 119.7 degrees Fahrenheit.
  • the water temperature tested in the kitchen read 115.20 degrees Fahrenheit.
  • located at the end of the resident hallway is the laundry closet and houses a washer and dryer.
  • also located in the hallway is a half bathroom equipped with a sink and a toilet and is primarily used by staff and visitors. A grab bar was observed.
  • per review of the food supply, plenty of perishables for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed. However, a recommendation was made to supplement the non-perishable foods to accommodate staff during an emergency.
  • the auditory device in bedroom #3 and the front door were tested and were operational.
  • the only fire extinguisher located in the kitchen was purchased on 3/16/26
  • the first aid kit was reviewed and met requirements.
  • the smoke detectors located in all the resident rooms, hallway and the only combination smoke/carbon monoxide detector located in the living room were tested and were operational.
  • full bed rails were observed on the left bed in bedroom #1 and the right bed in bedroom #2 and no written physicians orders were observed. The back bed in bedroom #3 was equipped with a half bed rail and there was a physician's order on file.
  • All staff have current first aid and CPR training.
  • the facility has current general liability insurance that meets Title 22 requirements.
  • Resident #4 who has been determined to bedridden was observed in bedroom #2.
  • the outside area is furnished with a table, chairs and an umbrella for outside activities. Also located outside is a storage shed.
  • Overall, all areas of the facility were observed to be clean.


Deficiencies were cited under California Code of Regulations, Title 22, Division 6 and Health and Safety Code. Immediate civil penalties of $500 was issued.
Exit interview was conducted, Appeals Rights were discussed and a copy was provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Christine Yee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 09/29/2026 12:25 AM - It Cannot Be Edited


Created By: Christine Yee On 09/24/2026 at 07:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOVE IS US
FACILITY NUMBER: 195850278

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(d)(1)
Incidental Medical and Dental Care Services
(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (1) Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above as it was revealed during record review that Resident #5 has PRN Furosemide 20mg, and there is no PRN Authorization Letter on file and no documentation kept for the doses dispensed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2026
Plan of Correction
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The Licensee will contact the prescribing doctor to obtain a completed PRN Authorization Letter that identifies whether the Resident #1 is able or unable to determine his/her own need for a prescription or nonprescription PRN medication. The Licensee will also document the date, time, dosage, reason for the medication and the results of the medication and any instructions provided by the physician.
Type B
Section Cited
CCR
87608(a)(3)
Postural Supports
(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited abov as it was observed that there are no written physician's order in Resident #1 and Resident #4 file to explain the need for the use of bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2026
Plan of Correction
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The Licensee will remove the full bed rails and contact Resident #1 and Resident #4's physician to obtain a written physician's order for the use of half bed rails if the doctor determines that they are needed by 10/1/26. Evidence of correction needs to be submitted by 10/1/26
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2026


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 09/29/2026 12:25 AM - It Cannot Be Edited


Created By: Christine Yee On 09/24/2026 at 07:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOVE IS US
FACILITY NUMBER: 195850278

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(a)(5)(B)
Postural Supports
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, intervriew and record review, the licensee did not comply with the section cited above as per review of Resident #1 and Resident #4 records, the residents are not on hospice and their beds are equipped with full bed rails and no written physician's order was observed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2026
Plan of Correction
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The Licensee will remove the full bed rails and obtain a written physician's order for 1/2 bedrails if the residents' doctor determine the need for any bed rails based on their medical assessment.
Type B
Section Cited
HSC
1569.72(f)
f) Notwithstanding the length of stay of a bedridden resident, every facility admitting or retaining a bedridden resident, as defined in this section, shall, within 48 hours of the resident’s admission or retention in the facility, notify the local fire authority with jurisdiction in the bedridden resident’s location of the estimated length of time the resident will retain his or her bedridden status in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above as the Administrator admitted that she did not notify the local fire authority iverbally or n writing that a bedriidden resident (R4) resides at the facility iwhich poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2026
Plan of Correction
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The Licensee will submit a written notice to the local fire authority that a bedridden resident resides at the facility by 10/1/26. Evidence of completion will be submitted to the Department also by 10/1/26
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2026


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 09/29/2026 12:25 AM - It Cannot Be Edited


Created By: Christine Yee On 09/24/2026 at 07:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOVE IS US
FACILITY NUMBER: 195850278

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87203
All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, interview and record review, the licensee did not comply with the section cited above as per record review, Resident #4 has been determined to be bedridden and was observed in bedroom #2. Bedroom #3 which has a direct exit to the outside is designated bedroom for bedridden use, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2026
Plan of Correction
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The Licensee will immediately relocate Resident #4 to the designated bedridden room or provide a written plan of action as to how the facility will come into complaince with the approprate placement of a bedridden resident based on the fire clearance approved by the fire authority by 9/25/26. Immediate civil penalties of $500 was assessed on today's visit.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date: 09/24/2026
Plan of Correction
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2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Christine Yee
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2026


LIC809 (FAS) - (06/04)
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