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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197611027
Report Date: 09/22/2026
Date Signed: 09/22/2026 02:50:20 PM

Document Has Been Signed on 09/22/2026 02:50 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CEDARS ASSISTED LIVINGFACILITY NUMBER:
197611027
ADMINISTRATOR/
DIRECTOR:		AGUINIGA, DAVIDFACILITY TYPE:
740
ADDRESS:17300 Roscoe BLVDTELEPHONE:
(818) 344-2042
CITY:NorthridgeSTATE: CAZIP CODE:
91325
CAPACITY: 175CENSUS: 122DATE:
09/22/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:08 AM
MET WITH:Stepan Sarmazian - Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 9/22/26, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan and Licensing Program Manager (LPM) Nichelle Gillyard conducted a Pre-Licensing Inspection and met with the Administrator Stepan Sarmazian. This is a Change of Ownership Application from facility " CEDARS ASSISTED LIVING, INC. 197608267" to “CEDARS ASSISTED LIVING INC. 197611027”. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 02/26/2026. Fire clearance was approved on 08/05/2026 for a total capacity of 175, of which 85 Ambulatory, 82 Non-ambulatory and 8 can be Bedridden in rooms #101, 103, 104, 105, 107, 108, 112, 114, 122, and 142. Delayed egress approved for 5 Memory Care Unit doors. Hospice waiver request will be submitted to the Department by 9/23/2026.

Today's site visit consisted of LPA/LPM touring the physical plant inside and outside the property and observed the following:

The facility is a two (2) story building, with residents’ rooms, private bathrooms, common areas: dining/living room, activity rooms, and multiple public bathrooms. At the time of this inspection, there were seventy-two (72) Assisted Living residents, thirty-four (34) Memory Care residents, 1 resident is bedridden, and one (1) resident receiving hospice care services. The facility has two (2) Memory Care Units: Evergreen is located on the second floor, and Willow is located on the ground floor. The Evergreen Memory Care section of the facility has its own activity, television, dining area and patio area. The door has a code and delayed egress on the doors. Willow Memory Care also has its own activity, television, dining area and patio area. There is one (1) medication room on the second floor.

Continue on LIC809-C

Nichelle Gillyard
Perchui Khurshudyan
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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CEDARS ASSISTED LIVING
FACILITY NUMBER: 197611027
VISIT DATE: 09/22/2026
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The Assisted Living Unit has its own activity room on the second floor, the dining area and a TV/Living room are on the first floor. The Assisted Living Unit has access to a huge patio area with proper seating for residents. There are two (2) elevators in the facility. There are three (3) stairways that have evacuation chairs. Roof access is inaccessible to residents. Evacuation routes are clearly labelled and posted throughout the facility.

COMMON AREAS: The facility maintains a comfortable temperature at 70-73°F. The Common areas are furnished with adequate furniture to accommodate a maximum capacity of 175 residents. This included living room furniture, a television, tables and chairs and a dining area. There is a functioning telephone on the premises. LPA/LPM observed license to be posted in a visible area along with the complaint poster and personal rights, including other required postings. Smoke and carbon monoxide detectors were located throughout the facility, and at 12:40pm they were tested and observed to be operational. LPA/LPM also observed fire extinguishers located throughout and outside of the facility, and they were last serviced on 04/06/2026. A fire inspection is conducted every year on the operation of the sprinkler system, electrical panels, water heaters, fire extinguishers, manual pull alarms, carbon monoxide detectors and smoke detectors. Copy of the inspection report was given to LPA. No obstructions, nor tripping hazards observed.

KITCHEN / DINING areas: The kitchen / meal preparation is located on the first floor. The kitchen is fully stocked with perishable and nonperishable foods, properly stored and labeled. Food is restocked regularly at least 2 times a week. The commercial refrigerators and freezers observed to maintain required temperatures, appliances and fixtures observed to be functional. Sharp knives/objects observed to be locked and inaccessible to residents in care at the time of the visit. The kitchen work area surface appeared generally clean, and no food items are stocked with cleaning supplies. Facility menu appears to meet the daily dietary needs of the residents. No pesticides, nor poisons were observed near any food areas. The residents with special dietary needs are posted in the kitchen prep area with pictures of the residents and their food choices or required preparation. The dining area is separated from the kitchen with a locked door. Residents do not have access to the kitchen area. At the time of the tour, different residents were observed having lunch with proper feeding utensils/plates/cups. Next to the kitchen/dining room area is a vending machine available for residents.

Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
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)
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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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CEDARS ASSISTED LIVING
FACILITY NUMBER: 197611027
VISIT DATE: 09/22/2026
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BEDROOMS: There are 175 beds designated for residents’ use. LPA/LPM observed accommodations in resident bedrooms and bathrooms for safety, privacy, and comfort. Random resident rooms were inspected and observed to maintain required furnishing and sufficient lighting, linens, blankets, closet space and dressers. All bedrooms were observed to be clean, sanitary, and clear of obstructions. Signaling system is present in all bedrooms to request staff assistance. LPA activated the signaling system in a randomly inspected bedroom and staff responded promptly. (Response time was within four (4) minutes).

Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor striping). Hot water temperature measured 112-122.9°F. The hot water tank was adjusted immediately during the visit. LPA requested 24 hour water temperature log submitted to the Department. The CAB will be notified about the hot water temperature log.

COMMON BATHROOMS: There are several common bathrooms throughout the upstairs and downstairs area. The staff and resident bathrooms are not shared. Sufficient supplies of toilet paper, napkins, and trash cans with lids were observed.

LAUNDRY ROOM: The laundry room is located on the ground floor. The washers/dryers appear to be in good condition. Laundry supplies are kept locked and inaccessible to residents in care.

MEDICATION ROOM: The facility has one designated Medication-room that is located on the 2nd floor by the Memory Care unit. The Med-room was observed to be locked and inaccessible to residents in care. There are always two (2) Med-techs in the facility to pass out medication. The facility also has two (2) MedCarts that were observed to be locked inside the medication room. Medications are properly labeled and stored. First aid kits were observed on each medication cart and stocked with required supplies.

SURROUNDING GROUNDS: There is a gated parking lot at the back of the facility. The facility has sufficient yard space. LPA/LPM observed appropriate outdoor furniture, with a covered shaded area for the residents. No bodies of water.

An emergency exit plan/sketch along with other posting requirements were available in the hallway next to the entrance. Facility’s main doors are the primary entry/exit access point, with three (3) emergency exits being located off the garden area, parking lot, and three stairwells. Emergency exit routes are clear of obstructions.

Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
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: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CEDARS ASSISTED LIVING
FACILITY NUMBER: 197611027
VISIT DATE: 09/22/2026
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In addition to the Pre-Licensing inspection, a Component III power point presentation was conducted at 10:00am. LPA/LPM discussed the following which include but is not limited to Component III; care and supervision, reporting requirements, preplacement, criminal record, food service, medications and maintaining physical plant and resident/staff records, house rules, and restricted health conditions.

Due to FAS error during the inspection, a printed copy of the Inspection Tool was provided to the Administrator.

Pursuant to Title 22, CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised.

OTHER:

. The Administrator has expressed interest in receiving Technical Support Program (TSP) assistance. The LPA will submit a TSP request for the facility once it becomes licensed. The request will cover the following areas: Dementia Care, Medication, and Care and Supervision.

. LPA/LPM suggested that monthly disaster drills be announced to residents so that those who are interested may participate in the training.

. Laundry services will be provided separately for each resident to prevent clothing from being mixed. Alternatively, a laundry net will be used for each resident’s clothing to keep items separated.

. Staff will ensure that snacks are provided to all residents in the facility. Staff will check residents’ rooms on both floors and offer snacks as needed.

. The Administrator will contact the Building and Safety Department to obtain approval for the installation of handicap-accessible doors in the dining room area and at the first-floor exit leading to the courtyard.

. LIC 309 will be updated to include the list of the corporation’s managing members, along with their names and titles. The updated LIC309 will be submitted to the Department by 9/23/26.

There were no immediate health and safety hazards observed at the time of this inspection.

Exit interview was conducted and a copy of this report was signed and delivered to facility Administrator.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
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)
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