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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850465
Report Date: 09/23/2026
Date Signed: 09/23/2026 03:44:40 PM

Document Has Been Signed on 09/23/2026 03:44 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:DREAM HAVEN CAREFACILITY NUMBER:
195850465
ADMINISTRATOR/
DIRECTOR:		TSATURYAN, SEVAKFACILITY TYPE:
740
ADDRESS:22411 BURBANK BLVDTELEPHONE:
(909) 280-0040
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 6CENSUS: 5DATE:
09/23/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Maya MoskovyanTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Angela Barutyan and Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 9:32AM. The LPAs met with Staff who contacted the Administrator. The Administrator Maya Moskovyan arrived shortly thereafter. Entrance interview conducted.

Beginning at 9:40AM, the LPAs, Staff, and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The LPAs observed knives and cleaning supplies stored inaccessible in the kitchen. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food and water. The LPAs advised the Administrator to obtain additional emergency water, which was obtained during the visit. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. The LPAs observed a resident’s refrigerated medication that was not secured. The Staff explained the medication bottle itself was secured and that it did not pose a risk to the residents if accessed. The LPAs informed them that all centrally stored medications are required to be secured and inaccessible. The Administrator stated the facility has a lock box for refrigerated medications and LPAs observed the Administrator to secure the refrigerated medication. The remainder of centrally stored medications were secured in a cabinet.


Report Continued on LIC 809-C
Kristin Heffernan
Angela Barutyan
DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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.

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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: DREAM HAVEN CARE
FACILITY NUMBER: 195850465
VISIT DATE: 09/23/2026
NARRATIVE
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COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. A fireplace was observed to be properly screened in the dining area. There was an office located near the kitchen with a laundry closet that was not secured during the visit. Machines were observed to be in good condition, and laundry detergent was observed. The facility maintained a comfortable temperature throughout the visit. Required postings were observed in the entryway along with a closet containing general supplies. Smoke and carbon monoxide detectors were tested at 10:21AM and were operational. LPAs observed the fire door to the hallway that was kept open with a tie on the handle, preventing it from shutting during LPAs’ smoke detector testing. LPAs explained that fire doors shall not be restricted. Administrator stated she will obtain a magnetic door stopper that is in compliance with fire code.

BEDROOMS/RESTROOMS: There were four (4) bedrooms total. Bedroom #4 is cleared for one (1) bedridden resident and had a direct exit to the outside. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom #4’s mattress did not have a fitted sheet. The Staff and Administrator stated that they were laundering the linens; however, the LPAs did not observe the laundry machines to be in use during the visit. They then explained that the resident often soils their bed and requires a waterproof mattress pad, which was observed in lieu of the fitted sheet. The LPAs explained that regardless of the reason, the facility is required to ensure linens are provided at all times. LPAs observed staff put the fitted sheet on the mattress. Extra linens and supplies were stored in hallway cabinets. There were two (2) total restrooms in the facility: one (1) private resident restroom and one (1) shared resident restroom. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap and paper products. Hot water was tested and measured between 107.6 degrees F and 125.8 degrees F, which is not within the required range. Administrator lowered the water heater during the visit.

OUTDOOR AREA: The surrounding grounds had a shaded patio area equipped with furniture in good condition for resident and visitor use. The rear property had two (2) additional dwelling units (ADUs) that were unrelated to the facility’s operations. Three (3) emergency side exits were observed and all were locked with padlocks. The Administrator stated that Staff have the key and the LPAs explained that emergency exits should be unlocked in the event of emergencies. LPAs observed the facility’s fire clearance, which does not approve the use of a locked or secured perimeter. LPAs explained that the locked exits are a violation of the facility’s fire clearance. Staff removed the locks during the visit. Report Continued on LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026
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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: DREAM HAVEN CARE
FACILITY NUMBER: 195850465
VISIT DATE: 09/23/2026
NARRATIVE
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MEDICATIONS: Medication review began at 10:29AM. Medications were centrally stored and kept inaccessible in the kitchen. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. Resident #1 (R1) did not have a centrally stored medication and destruction record. The Administrator stated that the resident was admitted on 09/18/2026, and they have not completed a medication record as the resident will be moving to another facility tomorrow, 09/23/2026. LPAs explained that R1 should still have a record as they are a resident at this facility.

RECORDS: Record review began at 01:14PM. Five (5) out of five (5) resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. The Administrator stated that R1 did not have a complete record as they had seven (7) days to complete and noted that an admission agreement was not signed upon admission. The LPAs explained that all residents should have a signed admission agreement and assessment prior to admission. Three (3) personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Two (2) personnel files were missing valid health screenings and TB tests, and one (1) staff file was missing First Aid/CPR training.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 09/01/2026. A fire extinguisher was observed and was last purchased on 09/17/2026.

An immediate civil penalty in the amount of $500 was assessed for a violation of the facility’s fire clearance. The Administrator was advised that failure to correct or continued violation may result in additional civil penalties. Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code the following deficiencies were cited (Refer to LIC 809-D).

Administrator was unable to stay for the remainder of the visit and designated staff member, Naira Gevorgyan, to sign the report.

Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Angela Barutyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/23/2026 03:44 PM - It Cannot Be Edited


Created By: Angela Barutyan On 09/23/2026 at 02:34 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: DREAM HAVEN CARE
FACILITY NUMBER: 195850465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87202(a)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as exterior exits were locked and the hallway fire door was tied open which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2026
Plan of Correction
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Staff untied the fire door during the visit and removed all of the padlocks on the exterior exits. Administrator will submit a signed statement of understanding of the section cited above by POC due date.
Type A
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as the hallway bathroom hot water measured at 125.8 degrees F, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2026
Plan of Correction
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Administrator lowered the water heater during the visit. Administrator will submit a video of the water temperature testing to CCLD by due date.
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:
Angela Barutyan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2026


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Document Has Been Signed on 09/23/2026 03:44 PM - It Cannot Be Edited


Created By: Angela Barutyan On 09/23/2026 at 02:34 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: DREAM HAVEN CARE
FACILITY NUMBER: 195850465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(2)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as one (1) medication was accessible in the refrigerator which posed an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2026
Plan of Correction
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Administrator secured the medication in a locked box in the refrigerator during the visit. POC is cleared.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:
Angela Barutyan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/23/2026 03:44 PM - It Cannot Be Edited


Created By: Angela Barutyan On 09/23/2026 at 02:34 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: DREAM HAVEN CARE
FACILITY NUMBER: 195850465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87307(a)(3)(C)
Personal Accommodations and Services
(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as one (1) resdident bed was missing bed sheets which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2026
Plan of Correction
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Staff equipped bed sheets on the mattress during the visit. POC is cleared.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:
Angela Barutyan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/23/2026 03:44 PM - It Cannot Be Edited


Created By: Angela Barutyan On 09/23/2026 at 02:34 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: DREAM HAVEN CARE
FACILITY NUMBER: 195850465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(f)
Personnel Requirements - General
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as two (2) out of three (3) staff members were missing valid health screenings and TB tests which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2026
Plan of Correction
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Administrator stated that staff will obtain health screenings and TB tests and will submit proof to CCLD by due date.

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:
Angela Barutyan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/23/2026 03:44 PM - It Cannot Be Edited


Created By: Angela Barutyan On 09/23/2026 at 02:34 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: DREAM HAVEN CARE
FACILITY NUMBER: 195850465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87506(a)
Resident Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above as one (1) resident did not have a complete file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2026
Plan of Correction
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2
3
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Administrator stated that the resident was admitted on 09/18/2026 and is moving to another facility by 09/24/2026. Administrator will submit a signed statement of understanding of the section cited by POC due date and stated that all documentation will be completed prior to or upon admission for prospective residents.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
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:
Angela Barutyan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2026


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