Dignity Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced One (1) Year Required visit to this facility. LPA met with Administrator Nirvana Mahmoodzadeh and explained the reason for the visit. At 8:45 AM, with the assistance of the administrator, a tour of the physical plant was conducted and the following was observed: This facility is a single storey building with five (5) bedrooms and four (4) bathrooms. One (1) bedroom and one (1) bathroom is designated for staff use only. This facility is fire cleared for six (6) non-ambulatory residents on Room 2,3 & 4, one (1) of which maybe bedridden on Room #3 only. Two (2) bedrooms (Room #1 & 5) are for ambulatory resident only. Hospice waiver for six (6) residents. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and sink. There was an adequate supply of perishable and non-perishable food in the facility Knives were observed locked in a kitchen cabinet. Cleaning supplies observed locked underneath the kitchen sink. BEDROOMS: There are three (3) bedrooms designated for client use. All three (3 bedrooms will be shared. The bedrooms were observed to have appropriate furniture and sufficient lighting. There are sufficient stock of linens in the storage. LAUNDRY ROOM: The laundry area is located in the backyard. It was observed to be locked during visit. GARAGE is attached to the house but has no access from the inside, it is also being used as emergency food, PPE, tools, frozen food and other miscellaneous storage. (continued on LIC 809-C) (continued from LIC 809) BATHROOMS: The facility has four (4) bathrooms. Bedroom #1 has its own bathroom with shower and designated for staff use only. The other two (2) bathrooms is located in the common area, by the kitchen bedrooms and by the dining area. One (1) other bathroom is in Room #5. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at a range of 113.6°7 to 117.7°F COMMON AREAS: These included the living room and dining room areas. The living room has a couch, chair, table, and television. The dining room has a table large enough to seat six (6) residents. The smoke alarms and carbon monoxide detector are dual and inter-connected. The facility has a fire extinguisher located by the dining area and hallway and last inspected on 09/01/26. MEDICATIONS: Medications will be kept locked in the bedroom hallway cabinet. Complete First aid kit is located by the medication cabinet. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has outdoor furniture for resident to hold activities. There is a tool shed at the back but was observed to be locked during visit. There is no body of water in the facility. Records: LPA reviewed records of six (6) residents and three (3) staff members. Resident and staff records appeared to be complete and updated. Disaster drill was last conducted on 08/03/26. Required posting observed in facility (complaint hot line poster). Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 26, 2026

Type of visit: Office

At 11:00 a.m. on 03/23/2026, Licensing Program Analysts (LPAs) Tihesha Smith and Gary Tan met with Licensees Nirvana Ghaemi Mahmoodzadeh, Noraet Neshan and Nona Virbyan Applicant/Licensee pending RCFE application for "Devoted Assisted Living" at the Woodland Hills-South Adult and Senior Care Regional Office for a Non-Compliance Conference (NCC). On 02/20/2026 Woodland Hills South Regional Office, received a complaint alleging “Unlicensed Care was being provided at 9229 Valjean Ave, North Hills CA 91343”. During course of investigation, it was determined that there is a pending RCFE application submitted for the above Unlicensed Location and the Licensees of Dignity Assisted Living Inc were involved in the Unlicensed operations conducted at the location. The licensees, who are also certified administrators with the Department of Social Services were given an opportunity to explain the reasons for their involvement in the Unlicensed operation. (Cont from 809) During this meeting LPA Tihesha Smith was able to request additional information regarding the unlicensed complaint. The licenses of DIGNITY ASSISTED LIVING LLC and prospective applicants for DEVOTED CARE ASSISTED LIVING were informed that continued involvement in Unlicensed operations may lead to denial of application and other possible adverse actions as the Department Deemed necessary. In addition, during this meeting, LPM and LPAs discussed other issues and citations issued to this facility during various Licensing Visits conducted on 02/18/2026 and on 03/04/2026. The Licensee was cited for missing staff records and for allowing two (02) individuals to work for the facility prior to obtaining criminal record clearance and association to the facility. After reviewing the facility compliance history, recent deficiencies and other points of concern, at the time of this visit an additional deficiency was issued for insufficient administrator qualifications and duties. Deficiency is issued on the corresponding LIC 809-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 23, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(1) · Plan of correction due date: Apr 15, 2026

87405 Administrator - Qualifications and Duties - (d) The administrator shall have the qualifications... (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not met as evidenced by: Based on interviews and observation, the licensee did not comply with the section cited above which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 23, 2026

Plan of correction: Licensees informed already finished 20 hrs and agreed to get additional vendored training for administrator qualifications. POC due date: 04/15/26

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Case Management - Other visit to this facility to add information to the Case Management - Deficiencies visit conducted on 02/18/2026 and correct the amount assessed on the Civil Penalty (421BG). Further record review of the Personnel Report (LIC 500) revealed Staff #1(S1) had a hired date of 8/22/2025 and Staff #2(S2) had a hired date of 2/14/2026. Based on interviews with the administrator on 02/18/2026 and residents, staff members worked in the facility and provided care and supervision to the residents since their hired date. Civil Penalty (LIC421BG) is being assessed to include $400 for each staff member. On 02/18/2026, the facility was assessed a civil penalty of $100 per staff, totaling $200. On 03/05/2026, an additional civil penalty was assessed for the deficiency cited on 02/18/2026 at $400 per staff, totaling $800 for today. No health or safety issues or concerns observed. Exit interview conducted. Civil Penalty Assessed for the remaining amount. Copy of report provided to Licensee.the state’s words, verbatim · CDSS document, Mar 5, 2026

Allegation investigated: Staff did not clean the facility. Staff did not keep facility from being malodorous.

On 02/18/2026 at 9:15 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit to this facility to investigate the above allegations. Upon arrival, LPA met with Staff #1 (S1) and requested that S1 contact the Administrator. LPA met with the Administrator, Nirvana Mahmoodzadeh shortly after and explained the reason for the visit. In the facility there were six (6) residents and two (2) staff. LPA requested a copy of the Register of Facility Residents (LIC9020) and Personnel Report (LIC500). LPA Rios initiated a physical plant inspection at approximately 9:29 a.m. LPA did not observe any immediate health or safety concerns with the physical plant. From 9:29 a.m. to 10:30 a.m., LPA interviewed five (5) out of six (6) residents. An interview was attempted with one resident; however, the resident did not provide responses related to the allegation. LPA also conducted interviews with S1 and the Administrator. During the physical plant inspection LPA focused on the facility kitchen, three (3) shared bedrooms and two (2) bathrooms. LPA also requested and reviewed staff records for S1 and Staff #2(S2). (Continue to LIC9099-C) Unsubstantiated Allegation: Staff did not clean the facility. In regards to the allegation it was reported that the kitchen floors were grimy and dirty, and that multiple towels on the floor appeared used and old. During the physical plant tour, LPA Rios did not observe the kitchen floors to be dirty or sticky, nor were any towels observed on the floor. LPA observed hampers for residents to place their dirty laundry. According to S1 cleaning rags are kept separate and laundered on their own. LPA's interviews with residents did not corroborate the allegation. LPA's interviews with the caregiver and the Administrator also denied the allegation. The caregiver reported that the kitchen floors are mopped after meals and at least every morning and evening. Based on the LPA’s observations and interviews, the allegation, staff did not clean the facility is deemed Unsubstantiated at this time. Allegation: Staff did not keep facility from being malodorous. In regards to the allegation, it was reported that the facility had a strong odor of urine and bleach. During the physical plant tour, LPA Rios did not detect any foul odors or strong scents of cleaning products. The Administrator stated that the facility uses Fabuloso to mop the floors and Lysol products to clean the bathrooms. LPA also observed Clorox stored in the laundry area. LPA's interviews with residents did not corroborate the allegation. One (1) resident reported that the facility has not had bad odors and that while the home may occasionally smell of cleaning products, it does not bother them. Staff interviews further indicated that they have not received complaints from residents regarding cleaning product odors or unpleasant smells. Based on the LPA’s observations and interviews, the allegation, staff did not keep facility from being malodorous is deemed Unsubstantiated at this time. Exit interview was conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 31-AS-20260209085900

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Evelin Rios conducted a Case Management - Deficiencies visit in conjunction with the complaint control number 31-AS-20260209085900 investigation today. Upon entry to the facility, LPA observed two staff members, Staff #1 (S1) and Staff #2 (S2), providing assistance with activities of daily living to residents. LPA requested the Personnel Report (LIC 500) from the Administrator, who provided a copy that was being updated during the visit. LPA’s review of the facility’s roster in Guardian showed only the Administrator and one additional individual, who was not present at the facility, as cleared and associated. During LPA's interview with the Administrator they stated that a criminal record transfer request had been submitted for S1 and wasn't sure why S1 was not showing up as associated. S2 had recently started working, and the Administrator reported they were in the process of obtaining fingerprint clearance. LPA requested to review staff files, however, the Administrator was unable to provide them, stating that they were not physically at the facility because they were in the process of organizing the files. Deficiency issued (refer to LIC809-D). Civil penalty assessed (refer to LIC 421BG). Appeals provided. Copy report issued.the state’s words, verbatim · CDSS document, Feb 18, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Feb 19, 2026

Criminal Record Clearance (e) All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility: 2)Obtain a California clearance or a criminal record exemption as required by the Department... This requirement was not met as evidence by: Based on interviews, and Guardian record review the licensee did not comply with the section cited above in having S2 working on 02/18/2026 without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: The licensee agreed that the staff member will not return to work until fingerprint clearance is completed and the staff member is properly associated to the facility. The licensee will provide a copy of the fingerprint clearance to the LPA once obtained.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(3) · Plan of correction due date: Feb 19, 2026

Criminal Record Clearance (e) All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility:(3) Request a transfer of a criminal record clearance as specified in Section 87355(c)... Based on interview, and Guardian record review the licensee did not comply with the section cited above by not associating the S1 to the facility since, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Licensee agreed that the staff member will not return to work until they are properly associated to the facility. The licensee shall complete the association process and provide proof of association to the LPA by 02/19/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(g) · Plan of correction due date: Feb 27, 2026

Personnel Records (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. Based on interviews, the licensee did not comply with the section cited above in not having S1's and S2's records readily available for review which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: The administrator agreed to bring files to the facility and provide copies to LPA by 02/27/2025.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jose Tan conducted an announced Pre-Licensing Inspection with the applicant representative and Administrator Nirvana Mahmoodzaoeh and Noraet Neshayn. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 01/09/25 A fire clearance was approved on 05/29/25 for six (6) non-ambulatory residents on Room 2,3 & 4 only, one (1) of which maybe bedridden on Room #3 only. Two (2) bedrooms (Room #1 & 5) are for ambulatory resident only. The applicant will also be requesting a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are dual and inter-connected. The facility has a brand-new fire extinguishers located by the dining area and hallway and last purchased on 08/08/25. At 9:27 AM, with the assistance of the administrator and applicant representative, a tour of the physical plant was in and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and sink. There was an adequate supply of non-perishable food items observed. Perishable food items not required at this time as there are no residents. Administrator was advised facility needs to carry perishable food items once they admit residents for care. Knives were observed locked in a kitchen cabinet. Cleaning supplies observed locked underneath the kitchen sink. BEDROOMS: There are three (3) bedrooms designated for client use. All three (3 bedrooms will be shared. The bedrooms were observed to have appropriate furniture and sufficient lighting. (continued on LIC 809-C) (continued from LIC 809) BATHROOMS: The facility has four (4) bathrooms. Bedroom #1 has its own bathroom with shower and designated for staff use only. The other two (2) bathrooms is located in the common area, by the kitchen bedrooms and by the dining area. One (1) other bathroom is in Room #5. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at a range of 114.6°F to 115.9°F COMMON AREAS: These included the living room and dining room areas. The living room has a couch, chair, table, and television. There is a shaded area with furniture in the backyard for residents' use. The dining room has a table large enough to seat six (6) residents. LAUNDRY ROOM: The laundry area is located in the backyard. It was observed to be locked during visit. GARAGE is attached to the house but has no access from the inside, it is also being used as emergency food, PPE, tools, frozen food and other miscellaneous storage. MEDICATIONS: Medications will be kept locked in the bedroom hallway cabinet. Complete First aid kit is located by the medication cabinet. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility is large enough to hold outdoor activities. There is a tool shed at the back but was observed to be locked during visit. There is no body of water in the facility. Component III orientation was waived with the approval of LPM Troy Agard as the would be administrator Nirvana Mahmoodzaoeh Ghaemi has more than three (3) years experience as an Administrator. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready to be licensed. CAB will be advised and a copy of this report provided Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 8, 2025

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: NIRVANA MAHMOODZADEH, NORAET NESHAN Interview Method: Telephone interview On July 01, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 1, 2025