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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850549
Report Date: 09/22/2026
Date Signed: 09/22/2026 04:03:20 PM

Document Has Been Signed on 09/22/2026 04:03 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:VALLEY PARADISE BOARDING CAREFACILITY NUMBER:
195850549
ADMINISTRATOR/
DIRECTOR:		NIKOYAN, NAIRAFACILITY TYPE:
740
ADDRESS:12200 HATTERAS STTELEPHONE:
(818) 853-7278
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY: 6CENSUS: 5DATE:
09/22/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:32 AM
MET WITH:Naira NikoyanTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Trevor Byrne conducted a case management - deficiencies visit at the facility. LPA arrived to the facility at 10:32 AM. LPA met with the facility staff who contacted the Administrator Naira Nikoyan. The Administrator arrived to the facility shortly after. Entrance interview conducted and the reason for the visit was explained.

During today’s visit LPA conducted a physical plant tour, conducted a file review for five (5) residents, collected copies of pertinent documents, and interviewed the Administrator and four (4) residents between approximately 10:35 AM

During the physical plant tour LPA observed three (3) resident beds to have full length bed rails installed. LPA interviewed the Administrator who confirmed that no current residents in the facility were receiving care from a hospice provider. LPA informed the Administrator that 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. The Administrator expressed understanding and agreed to either remove the full length bed rails from the identified resident’s beds or to submit an exception request to the department to retain the full bed rails.

During the physical plant tour LPA observed multiple unsecured prescription and non-prescription medication bottles in resident bedrooms. LPA reviewed resident files and observed three (3) resident’s physician reports which indicated that the residents were not able to store their own medications. LPA informed that Administrator that due to physical arrangements in the facility and the condition or the habits of other persons in the facility medications shall be centrally stored. The Administrator expressed understanding and agreed to properly store all prescription and non-prescription medications at the facility. CONTINUED ON LIC 809C.

Kasandra Lopez
Trevor Byrne
DATE: 09/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2026
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VALLEY PARADISE BOARDING CARE
FACILITY NUMBER: 195850549
VISIT DATE: 09/22/2026
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During record review LPA observed one (1) resident file to be missing a completed medical assessment and proof of a negative TB test. LPA informed the Administrator that the facility shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. The Administrator stated that the facility does have a medical assessment for the resident but that the document was removed by the resident’s responsible party to be updated. The Administrator agreed to submit proof of the completed medical assessment to the department.

The following deficiencies were cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.

NAME OF LICENSING PROGRAM MANAGER: Kasandra Lopez
NAME OF LICENSING PROGRAM ANALYST: Trevor Byrne
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 09/22/2026 04:03 PM - It Cannot Be Edited


Created By: Trevor Byrne On 09/22/2026 at 03:31 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: VALLEY PARADISE BOARDING CARE
FACILITY NUMBER: 195850549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2026
Section Cited
CCR
87608(a)

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87608 Postural Supports
(a)...Postural supports may be used under the following conditions. (5) ...
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care...
This requirement is not met as evidenced by:
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The Administrator agreed to either remove the full length bed rails from the identified resident’s beds or to submit an exception request to the department to retain the full bed rails to CCLD no later than POC due date.
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Based on observation and record review the Licensee did not comply with the section cited above as three residents who were not receiving hospice care had full length bed rails installed on their bed which poses a potential personal rights risk to clients in care.
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Type B
10/06/2026
Section Cited
CCR87465(h)(1)(C)

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87465 Incidental Medical and Dental...
(h) The following...shall apply...
(1) Medications shall be centrally stored...
(C)...due to physical arrangements in the facility and the condition or the habits of other persons in the facility...
This requirement is not met as evidenced by:
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The Administrator agreed to properly store all prescription and non-prescription medications at the facility and to submit proof of appropriate storage to CCLD no later than POC due date.
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Based on observation and record review the Licensee did not comply with the section cited above as multiple prescription and non-prescription medications were left unsecured at the facility which poses a potential health to clients in care.
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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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/22/2026 04:03 PM - It Cannot Be Edited


Created By: Trevor Byrne On 09/22/2026 at 03:36 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: VALLEY PARADISE BOARDING CARE
FACILITY NUMBER: 195850549

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2026
Section Cited
CCR
87458(a)

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87458 Medical Assessment
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment...to be kept in the resident's record.
This requirement is not met as evidenced by:
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The Administrator agreed to submit proof of the completed medical assessment to CCLD no later than POC due date.
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Based on record review the Licensee did not comply with the section cited above as one resident file was missing proof of a completed medical assessment which poses a potential health risk to clients in care.
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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.
Kasandra Lopez
NAME OF LICENSING PROGRAM MANAGER:
Trevor Byrne
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2026


LIC809 (FAS) - (06/04)
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