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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191222081
Report Date: 05/30/2025
Date Signed: 05/30/2025 01:53:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250206151438
FACILITY NAME:ARARAT HOME OF LOS ANGELESFACILITY NUMBER:
191222081
ADMINISTRATOR:RITA NORAVIANFACILITY TYPE:
741
ADDRESS:15105 MISSION HILLS RD.TELEPHONE:
(818) 365-3000
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY:186CENSUS: 75DATE:
05/30/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rita Noravian - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not prevent a resident from falling and sustaining injuries while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to investigate the above allegation. LPA met with Administrator Rita Noravian and explained the reason for the visit.

LPA conducted physical plant tour at 9:44 AM, requested copies of facility documents relevant to the investigation at 10:22 AM, reviewed records between 10:30 AM to 11:30 AM and interviewed staff between 11:30 AM to 1:00 PM. Regarding the allegation that Staff did not prevent a resident from falling and sustaining injuries while in care, it was alleged that Resident #1 (R1) had an unwitnessed fall while at the facility 01/30/25 and that R1 was not a fall risk and could ambulate well, which makes the fall suspicious. LPA's record review today between 10:30 AM to 11:30 AM revealed that R1 was non-ambulatory but able to transfer independently to and from bed and had the capacity for self-care including but not limited to bathing, dressing, grooming, feeding and toileting. R1 was able to ambulate on R1's own using walker. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20250206151438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ARARAT HOME OF LOS ANGELES
FACILITY NUMBER: 191222081
VISIT DATE: 05/30/2025
NARRATIVE
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(continued from LIC 9099)

LPA's interview with R1's friend Resident #3 (R3) today at 11:39 AM, revealed that R1 always go around with a walker with R3 all the time especially during mealtime and did not witness R1 falling at any time. R3 did not witness R1's fall on 01/30/25. LPA's interview with the first staff who saw R1 on the floor revealed that the staff saw R1 walking without a walker heading to the direction leading to the dining room on the first floor which is unusual because R1 always go down in the main dining room in the lobby floor. Staff passed by R1 but when staff came back after delivering tray to the residents on the first floor, staff saw R1 on the floor and called other staff to assist R1. R1 was assessed by the facility Resident Care Director who is also a Licensed Vocational Nurse (LVN), put on a wheelchair and applied first aid. R1's family member was informed who eventually brought R1 to the hospital for further evaluation. LPA’s interview with the administrator on 02/13/25 at 12:35 PM, revealed that R1 usually walk with a walker but during the incident R1 was not using R1’s walker, the Administrator added that R1 may have forgotten that R1 was using a walker to ambulate as R1 has a Dementia diagnosis.

Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025
LIC9099 (FAS) - (06/04)
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