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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850166
Report Date: 02/25/2025
Date Signed: 02/25/2025 03:06:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/19/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20250219161649
FACILITY NAME:AAA QUALITY RESIDENTIAL CARE FACILITYFACILITY NUMBER:
195850166
ADMINISTRATOR:KIRAKOSYAN, ELENFACILITY TYPE:
740
ADDRESS:7843 STANSBURY AVE.TELEPHONE:
(323) 485-4851
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 6DATE:
02/25/2025
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Ovsanna KhayalyanTIME COMPLETED:
02:57 PM
ALLEGATION(S):
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Facility staff did not seek timely medical attention for resident.
Facility staff did not arrange transportation for resident in care.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced visit to investigate the allegations listed above. The LPA arrived at the facility and was greeted by staff. Staff contacted the Administrator via telephone. The Administrator Ovsanna Khayalyan arrived at 10:45 a.m.

LPA Urena toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. LPA Urena requested records pertinent to the investigation at 10:50 a.m. and interviewed the resident, Administrator, and staff between 10:25 a.m. to 12:50 p.m. LPA Urena was unable to reach the reporting party (RP), but was able to speak with R1's case worker (CW) from 1:05 p.m. to 1:46 p.m. CW stated that the RP was a temporary employee and is no longer working for the company.
Continues on LIC 9099C...


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
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 5
Control Number 29-AS-20250219161649
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AAA QUALITY RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 195850166
VISIT DATE: 02/25/2025
NARRATIVE
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Facility staff did not seek timely medical attention for resident.
On the allegation that Facility staff did not seek timely medical attention for resident, it is the concern of the reporting party (RP) that the resident (R1) was experiencing chest pains and the facility staff failed to observe the changes in condition and did not seek timely medical attention for R1. The interview with R1 revealed that on 02/18/2025 probably after 2:00 p.m. they were feeling fine when they decided to go on a walk in the community, however after some time during the walk they started to feel weak and knowing that the hospital was nearby, they decided to walk themselves to the hospital. At the hospital they were admitted after being diagnosed with pneumonia. R1 stated that the facility Administrator called them and it was at this time that R1 informed the Administrator that they were admitted to the hospital. Interviews with the Administrator and the staff revealed that they did not notice any changes in R1's condition on 02/18/2025. R1 had lunch that day and decided to go on a walk sometime after lunch. R1 had been admitted in the facility two days prior to the incident, and R1 was in good spirits.

Based on the information obtained through interviews, the allegation that facility staff did not seek timely medical attention for resident, is deemed Unsubstantiated at this time.

Facility staff did not arrange transportation for resident in care.


On the allegation that the Facility staff did not arrange transportation for resident in care, it is the concern of the RP that R1 was denied transportation to the hospital when they were not feeling well, and consequently R1 had to walk to the hospital. The interview with R1 revealed that on 02/18/2025, at around 2:00 p.m., they told the facility staff, “they were going on a walk”. R1 went stated that during the walk they felt weak. R1 stated that they know the area well and decided to walk to the nearby hospital, which is about 10 minutes of walking distance from the facility. R1 stated that they were confused, and ‘out of it’, when hospital staff interviewed them. R1 denied the statement provided by the RP in the complaint report. The interview with the Administrator revealed that R1 stated that they wanted to go on a walk. The Administrator stated that because R1 had been admitted to the facility only two days before, they were concerned about the walk, however R1 insisted on the walk. Furthermore, the Administrator stated that they told R1 to take the facility’s business card in case they got disoriented or lost and didn’t know how to get back. Per the Administrator R1 has a personal cell phone. The Administrator stated that they called R1 after 15 minutes but R1 did not answer the phone. After an hour passed, the Administrator called R1 again, at this time R1 answered the phone and R1 stated they were admitted to the hospital. The Administrator then informed R1’s emergency contacts that R1 was admitted to the hospital. Continues on pg. 3
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250219161649
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AAA QUALITY RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 195850166
VISIT DATE: 02/25/2025
NARRATIVE
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Page 3.
The LPA spoke with a R1’s case worker (CW) assigned to follow up with R1 for a month after placement at the facility. The CW stated that case notes dated 02/21/2025 indicate that R1 stated that they are happy residing at this facility.

Based on the information obtained through record review and interviews, the allegation that facility staff did not arrange transportation for resident in care, is deemed Unsubstantiated at this time.

No citations were issued at this time. Exit interview was conducted and a copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/19/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20250219161649

FACILITY NAME:AAA QUALITY RESIDENTIAL CARE FACILITYFACILITY NUMBER:
195850166
ADMINISTRATOR:KIRAKOSYAN, ELENFACILITY TYPE:
740
ADDRESS:7843 STANSBURY AVE.TELEPHONE:
(323) 485-4851
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 6DATE:
02/25/2025
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Ovsanna KhayalyanTIME COMPLETED:
02:57 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff yells at resident in care.
Facility staff forces to eat.
Facility staff forces to take medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced visit to investigate the allegations listed above. The LPA arrived at the facility and was greeted by staff. Staff contacted the Administrator via telephone. The Administrator Ovsanna Khayalyan arrived at 10:45 a.m.

LPA Urena toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. LPA Urena interviewed the resident (R1), Administrator between 10:25 a.m. to 12:50 p.m. LPA Urena was unable to reach the reporting party (RP), but was able to speak with R1's case worker (CW) from 1:05 p.m. to 1:46 p.m. CW stated that the RP was a temporary employee and is no longer working for the company.
Continues on LIC 9099C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250219161649
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AAA QUALITY RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 195850166
VISIT DATE: 02/25/2025
NARRATIVE
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2
3
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5
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Facility staff yells at resident in care.
On the allegation that the facility staff yells at residents, the interview with the resident (R1), revealed that this allegation is based on different facility where they were previously residing, and that it was a mistake, wrong facility. Therefore, the allegation is deemed to be Unfounded, at this time.

Facility staff forces to eat.
On the allegation that the facility staff forces residents to eat, the interview with the resident (R1), revealed that this allegation is based on different facility where they were previously residing, and that it was a mistake, wrong facility. Therefore, the allegation is deemed to be Unfounded, at this time.


Facility staff forces to take medication.
On the allegation that the facility staff forces residents to take medication,the interview with the resident (R1), revealed that this allegation is based on different facility where they were previously residing, and that it was a mistake, wrong facility. Therefore, the allegation is deemed to be Unfounded, at this time.


Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5