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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610429
Report Date: 10/06/2026
Date Signed: 10/06/2026 05:31:08 PM

Document Has Been Signed on 10/06/2026 05:31 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SIMPLE TOUCH BOARD AND CARE INCFACILITY NUMBER:
197610429
ADMINISTRATOR/
DIRECTOR:		SARKISYAN, KARINEFACILITY TYPE:
740
ADDRESS:22317 MOBILE STTELEPHONE:
(747) 444-8506
CITY:CANOGA PARKSTATE: CAZIP CODE:
91303
CAPACITY: 6CENSUS: 2DATE:
10/06/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Karine Sarkisyan, Administrator TIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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At 10:20am, LPA Angela Panushkina conducted an unannounced visit related to complaint control #31-AS-20260929091919. LPA was let in by R1 and observed two residents unsupervised. During the facility tour, LPA noted that R1 was sitting in the living room with no lights on and that the medication cabinet was unlocked and accessible. LPA inspected all four (4) bedrooms and found no staff or additional residents present. In bathroom #1, LPA found R2 lying on the floor covered with comforters, with the bathroom heater on; R2 stated they preferred to stay there because it was the warmest area. No medical emergency was identified. LPA contacted the Administrator and was informed that she had stepped out to get Starbucks and would return shortly, arriving back at the facility at 10:41am.
Additional deficiencies will be cited for:
  • Beds in bedroom #2 and #4 were missing mattress, comforter, pillow, linens, etc.
  • During the visit, LPA was informed that R1 was admitted to this facility on 08/14/26 and from 08/14/26 to 09/28/26 facility did not administer R1's medications as prescribed, because R1 refused taking them. No incident report was submitted to the Community Care Licensing Department (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPA informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting.
Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Civil Penalties Assessed on LIC421IM
Exit interview conducted. Appeal rights explained and copy of this report signed and delivered.
Nichelle Gillyard
Angela Panushkina
DATE: 10/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2026
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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Document Has Been Signed on 10/06/2026 05:31 PM - It Cannot Be Edited


Created By: Angela Panushkina On 10/06/2026 at 12:48 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SIMPLE TOUCH BOARD AND CARE INC
FACILITY NUMBER: 197610429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/08/2026
Section Cited
CCR
87468.2(a)(4)

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(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities... (4) To care, supervision, and services that meet their individual needs and are delivered by staff... ... to meet thier needs.
This requirement is not met as evidenced by:
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Administrator agreed to schedule vendorized training by 10/08/26 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion
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Based on LPA observation and interview, licensee did not comply with the section cited above by leaving two (2) residents unattended in the facility from 10:20am to 10:41am, which posed an immediate health and safety risk to persons in care
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This is Zero Tolerance

*** Civil Penalties Assessed on LIC421IM***
Type A
10/08/2026
Section Cited
CCR87465(h)(2)

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Incidental Medical and Dental Care: (h) The following requirements shall apply... (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons...
This requirement is not met as evidenced by:
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The Administer will review the regulation and email LPA a statement of understanding along with photos of residents’ medication locked and inaccessible to persons in care.
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Based on interviews and LPA observation, licensee did not comply with the section cited above by leaving medication cabinet unlocked and accessible to residents in care, which posed/poses an immediate health, safety or personal rights risk to persons 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.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Angela Panushkina
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/06/2026 05:31 PM - It Cannot Be Edited


Created By: Angela Panushkina On 10/06/2026 at 02:40 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SIMPLE TOUCH BOARD AND CARE INC
FACILITY NUMBER: 197610429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2026
Section Cited
CCR
87307(a)(3)(C)

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Personal Accommodations and Services: (a) Living accommodations and grounds shall... (3) Equipment and supplies necessary for personal care... shall be readily available to each resident. (C) Clean linen, including blankets...
This requirement is not met as evidenced by:
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Administrator agreed to set all bedrooms designated for residents’ use with proper bedding, matrass and pillows and have it readily available. Pictures will shall be submitted to LPA by POC date.
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Based on LPA’s observations, the licensee failed to comply with the section cited above by not ensuring all resident bedrooms were prepared and readily available. This poses potential health and safety risk to persons in care
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Type B
10/13/2026
Section Cited
CCR87211(a)(1)A,B&D

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Requirements: (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)...
This requirement is not met as evidenced by:
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Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events.
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Baed on interviews and record reviews, licensd not comply with the section cited above by faily to notify CCLD regarding R1's prescribed medications not being administered (due to refusal). This posed/poses potential health and safety risk to persons in care.
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The Administrator will provide a written explanation describing how the deficiency will be corrected and how the issue will be prevented from recurring.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Angela Panushkina
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2026


LIC809 (FAS) - (06/04)
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