Devoted Care Assisted Living

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tihesha Smith conducted an announce pre-licensing visit at this facility. LPA Smith was greeted by Nirvana Ghaemi-Mahmoozadeh, Nona Virabyan, and Noraet Neshan (face recognition). Purpose of today’s visit is to inspect the facility to ensure that the facility is following the rules and regulations of California Code of Regulations, Title 22, Division 6. Today's site visit consisted of LPA Smith touring the physical plant inside and outside and the following was observed: The facility is a single-story building with a capacity of six (6). The common areas (kitchen, and combination living and dining room) were appropriately furnished, and lighting was adequate. The kitchen food preparation was observed to be sanitary. No perishable food currently however, a supply of nonperishable and canned food in kitchen cabinets. The sharps are stored and locked in kitchen drawer. Automated sink soap locked under kitchen sink cabinet. The appliances in the kitchen appeared to be new, clean and functional. The living and dining room furniture was observed to be functional with adequate seating at the table and on the sofas. A television is wall mounted in the living room area. Games and activities for residents are stored on living room table next to phone and first aid kit. The medications and toxins to be locked in hall closet across from main bathroom. Linens stored in closet near residents’ room. Laundry area is in kitchen closet. The laundry appliances observed to be new, clean and functional. (Cont from 809) There are two (2) fire extinguishers in the facility both observed to be charged: (1) fire extinguisher: attached to kitchen wall and the other attached to wall in residents’ hallway. Dual Smoke and Carbon Monoxide detectors were observed all over the facility, tested, and observed to be operational at time of visit. Dementia alarms on exit doors observed to be functional at time of visit. Emergency exit plan/sketch is posted on the living room wall along with other posting requirements. Additional emergency postings to bedrooms will be added. The facility has a total of six (6) bedrooms as follows: four (4) residents’ bedrooms with three (3) furnished with night stand, lamp, dresser, and chair and two (2) staff rooms. There are two (2) bathrooms in the facility. Bathrooms have trash cans, non-slip mats and grab bars. Bathroom water temperature measured at: 115 degrees Fahrenheit. Staff and residents’ files stored in cabinet in staff area in living Backyard has a patio area with large umbrella, table and eight (8) chairs that provide sufficient seating and are in good repair. Garage: Has additional refrigerator, stores of emergency food/water/supplies and equipment for facility only. Component III presentation was conducted at 11:25 am. and upon completion the administrator/licensee acknowledged understanding. No hazards observed during visit and facility is following title 22 regulations. A copy of this report will be sent to the CAB Specialist Exit interview conducted and copy of report giventhe state’s words, verbatim · CDSS document, Apr 9, 2026

Allegation investigated: Unlicensed Care being provided

Licensing Program Manager (LPM) Naira Margaryan, Licensing Program Analysts (LPAs) Tihesha Smith and Gary Tan met with Licensees Nirvana Ghaemi Mahmoodzadeh, Noraet Neshan and Licensee applicant Nona Virabyan at the Woodland Hills-South Adult and Senior Care Regional Office to deliver findings. Unlicensed Care being provided The Department received information that the home provided care for at least two (2) individuals living in the home without licensure. On 03/04/26 LPAs Tihesha Smith and Abeye Dugma made an unannounced initial 10-day complaint visit but were unable to reach anyone at the home. LPAs spoke with neighbors near home. Neighbors revealed they have seen elderly individuals at the home and access transportation at the home. Subsequent visits were conducted in the morning and afternoon on 03/16/26. Entry into the house was allowed at approximately 3:20 pm. Substantiated (cont from 9099C) The home is single story that has two (2) bathrooms and six (6) bedrooms; however, the Los Angeles County Assessor’s website lists the home having four (4) bedrooms and two (2) bathrooms and there is a pending application for licensure on file with CCLD for this location. LPA Smith conducted tour and observed there were no individuals in the home however at least one or more rooms had clothing, personal items, medication and appeared to be in use but male home guide unable to provide clear information regarding the observation. During follow-up contact via phone, email and in office applicant Nona Virbayan stated had no knowledge of unlicensed operation however, both Nirvana Ghaemi Mahmoodzadeh and Noraet Neshan admitted to providing care and supervision to six (6) individuals in the home. Based on the information obtained and operator admission it was determined that six (06) out of six (06) individuals residing in the home required and were receiving care and supervision to retain activities of daily living. Care and supervision include and not limited to assistance with medication, bathing and dressing. Therefore, the allegation of "Unlicensed Care" is SUBSTANTIATED at this time. A Notice of Operation in Violation of Law (NOVL) was issued. The operator was advised that a retroactive civil penalty of $100 per day per tenant shall be assessed on the 15th day from the original date of the Notice of Operation in Violation of the Law (Mar 4, 2026) for the operation of an unlicensed facility. If the operator has not ceased operation or submitted a completed application for licensure within 15 calendar days of the issuance of this notice on the 16th day from the notice, if the unlicensed operation continues to operate, a $200 per resident per day will be assessed until a completed application is submitted or the operation ceases. The operator may submit an application at the Woodland Hills Adult and Senior Care Regional Office located 21731 Ventura Blvd STE 250, Woodland Hills, 91364. The operator may go to www.ccld.ca.gov for orientation information. Exit interview conducted/Copy of the report given.the state’s words, verbatim · CDSS document, Mar 23, 2026 · control 31-AS-20260226151208

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.44 · Plan of correction due date: Mar 23, 2026

§1569.44 Unlicensed residential care facility for the elderly… (a) A facility shall be deemed to be an "unlicensed residential care facility for the elderly" … (1) The facility is providing care and supervision and (3) The facility retains residents who demonstrate the need for care and supervision. This requirement is not met as evidenced by: Based on operators admission all six individuals are receiving elements of care and supervision, which poses an immediate health and safety risk or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 23, 2026

Plan of correction: Pending application for licensure is on file. No individuls requiring care and supervision were in the home during tour of home on 03/16/26, in addition to Administrator provided email on 3/17/26 that all individuals have been relocated and during this office visit licensees/applicant will not have any indviduals in home until licensed.