195850166-4-30-2025-29-AS-KLOZ-DH77Q8-20250530215131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850166
Report Date: 04/29/2025
Date Signed: 04/30/2025 07:48:40 AM

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
04/14/2025 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20250414113412

FACILITY NAME:	AAA QUALITY RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	195850166
ADMINISTRATOR:	KIRAKOSYAN, ELEN		FACILITY TYPE:	740
ADDRESS:	7843 STANSBURY AVE.		TELEPHONE:	(323) 485-4851
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY:	6	CENSUS: 5	DATE:	04/29/2025
		UNANNOUNCED	TIME BEGAN:	03:18 PM
MET WITH:	Ovsanna Khayalyan		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff speak inappropriately towards a resident.
Staff mishandle a resident's medication.
Resident was physically abused while in care.
Staff are denying a resident access to food.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent visit to deliver the findings for the allegations listed above. The LPA was greeted by staff, and called the Administrator.The LPA explained the reason for the visit to the Administrator Ovsanna Khayalyan and read the report over on the phone. The Administrator allowed the facility staff to sign on the report.

On 04/17/2025, Licensing Program Analyst (LPA) Sandra Urena conducted an initial ten-day visit to investigate the allegations listed above. The LPA met with the Administrator Ovsanna Khayalyan and explained the reason for the visit. LPA Urena and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. No concerns were observed at this time. The LPA interviewed the Administrator, residents and staff from 10:05 a.m. to 01:25 p.m. Requested records pertinent to the investigation. Further investigation is needed at this time.Continues LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250414113412

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: 04/29/2025

NARRATIVE

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Pg. 2
Staff speak inappropriately towards a resident.
On the allegation that staff speak inappropriately towards resident, it is the concern of the reporting party (RP) that staff speak disrespectfully to residents in care. To investigate the allegation, LPA Urena conducted residents’ interviews. The LPA interviewed four (4) out of five (5) residents, one resident was unavailable for the interview. The interviews revealed that staff are never disrespectful, nor do they raise their voices. One resident stated that they thought they heard staff use loud voice but was not sure. Staff denied being disrespectful to residents in care.

Based on the information obtained through interviews, the residents stated that staff speaks to them respectfully.
Therefore, the allegation is deemed Unsubstituted at this time.

Staff mishandle a resident's medication.
On the allegation that staff mishandle a resident's medication; it is the concern of the reporting party that staff are not dispensing the medications to residents as prescribed (timely). To investigate the allegation, LPA Urena conducted residents’ and staff interviews and conducted a random medication audit of residents’ medications compared to the Centrally Stored Medication and Destruction Record (LIC622). The interview with residents revealed that they receive their medications on time and according to their doctor’s orders. The medication audit revealed that the medications selected for audit were accurately dispensed, per physician’s orders.

Based on the information obtained through interviews, and medication audit, the residents are receiving their medications according to the physician’s orders. Therefore, the allegation is deemed Unsubstantiated at this time.

Continues on LIC 9099C pg. 3

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250414113412

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: 04/29/2025

NARRATIVE

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Pg. 3
Resident was physically abused while in care.
On the allegation that a resident was physically abused while in care; it is the concern of the reporting party that the RP witnessed staff physically abusing an elderly resident. The reporting party did not specify how the physical abuse was being perpetrated, and neither identified the elderly resident. To investigate the allegation, LPA Urena conducted residents’ interviews and residents’ representative’s interviews. The interviews revealed that staff have not abused residents physically nor in any other way. Residents are happy with the care they receive from the staff and the Administrator. The LPA interviewed the RP and the RP denied witnessing any physical abuse. Staff denied being physically abusive towards residents in care. The Administrator stated that no concerns or reports of abuse have been brought up by residents or their representatives.

Based on the information obtained through interviews, residents reported that they are happy at the facility and denied any staff was physically abusing them. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff are denying a resident access to food.
On the allegation that staff are denying a resident access to food, it is the concern of the reporting party (RP) that staff are not allowing residents access to the kitchen until after 8:00 a.m. To investigate the allegation, LPA Urena conducted residents’ and staff interviews. The residents’ interviews revealed that they receive three meals a day plus they are offered several snacks throughout the day. If they get hungry, they can ask the staff for food. They are never denied food. The staff interviews revealed that they serve breakfast between 8:00 a.m. and 8:30 a.m. lunch between 12:30 p.m. and 1:00 p.m., snacks in between and dinner at around 5:00 p.m. The LPA interviewed the RP, and the RP recognized that the staff are trying to take care of R1’s health, and that they do not actually deny the food, and is more about the food being consumed late at night.

Based on the information obtained through interviews, RP denied being hungry or not having access to food or getting enough food during meals. Therefore, the allegation is deemed Unsubstantiated at this time.

No citations were issued. Exit interview was conducted. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

LIC9099 (FAS) - (06/04)

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