195850166-7-1-2025-29-AS-KLOZ-DJURRT-20250723131539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850166
Report Date: 07/01/2025
Date Signed: 07/01/2025 04:32:15 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
01/31/2025 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20250131163051

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:	07/01/2025
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Ovsanna Khayalyan		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident sustained unstageable pressure injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Urena met with the Administrator Ovsanna Khayalyan and explained the reason for the visit.

On 01/31/2025, the Woodland Hills Adult and Senior Care Regional Office (RO) received a complaint alleging facility employees at the AAA Quality Residential Care Facility failed to provide an appropriate level of care to Resident #1 (R1) resulting in R1 developing numerous pressure injuries with one being identified as unstageable. The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Douglas Real.

Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025

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 3

Control Number 29-AS-20250131163051

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: 07/01/2025

NARRATIVE

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Page 2.
On 02/05/2025, from 10:05am to 12:45pm, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial visit to investigate the allegation listed above. LPA Urena was greeted by staff and informed of the visit. The staff contacted the Administrator Ovsanna Khayalyan via telephone to inform them of the visit. The Administrator arrived at 10:45am and the LPA explained the reason for the visit.
The LPA requested records pertinent to the investigation at 10:55am and interviewed the Administrator from 11:09am to 11:57am. The Administrator was advised that the complaint was referred to the Investigations Branch (IB); however, an IB investigator had not yet been assigned as of the visit date. The LPA determined further investigation was needed prior to issuing findings.

On 02/24/2025, at approximately 11:55am, Investigator Real conducted interviews with Kaiser Permanente Hospital Social Worker; on 02/25/2025, from approximately 8:45am to 12:30pm, with County of Los Angeles Deputy Public Guardians; on 03/14/2025, at approximately 11:00am, with facility resident; on 04/15/2025, from approximately 10:00am to 1:00pm, with Staff #1 (S1), Administrator, and facility residents; on 05/22/2025, from approximately 11:45am to 1:15pm, with Los Angeles Police Department (LAPD) Detective and Sunshine Care Hospice Administrator; and on 05/29/2025, at approximately 12:00pm, with Sunshine Care Hospice Registered Nurse. In addition, Investigator Real reviewed Kaiser Permanente Hospital medical records, Los Angeles Public Guardian (LAPG) conservator court documents, Sunshine Care Hospice Records, and facility file documents related to the investigation. Due to the complaint was not reported to the LAPD as a crime report, a police report was not generated. Therefore, no investigation or interviews were conducted by the LAPD.

According to R1’s Physician’s Report, dated 07/29/2024, the report indicated R1 was diagnosed with Type II diabetes, atrial fibrillation, hypertension, and dementia. R1 was noted as having lower leg diabetic wounds. R1 was admitted to the facility on 07/30/2024.
Continues on LIC 9099C page 3....

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 29-AS-20250131163051

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: 07/01/2025

NARRATIVE

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Page 3.
A review of the Sunshine Care Hospice records revealed on 11/30/2024, R1 was placed on hospice with the primary diagnosis of Unspecified Protein-Calorie Malnutrition and the Secondary diagnosis as Senile Degeneration of the brain. The hospice certification period was listed as 11/30/2024 to 02/27/2025. Frequency of visits was noted as home aide 2 times per week, LVN 1 time per week, and RN every 2 weeks.

The Department’s investigation revealed R1 was under hospice care while residing in the facility and hospice was aware R1’s health was declining. According to R1’s hospice nurse, they saw no evidence to suggest that R1’s decline in health was due to neglect or abuse by the facility and believes R1’s decline was due to advanced dementia and possibly other comorbidities. R1’s hospice nurses instructed the facility caregivers to turn R1 every two hours, and the hospice nurse had no reason to believe the facility staff did not do so. R1 had a very poor appetite and frequently refused to eat or drink. This behavior likely contributed to R1’s skin breakdown leading to the unstageable pressure injury and the beginning of injuries on R1’s feet. Wound care was ordered through hospice to address the skin breakdown issues and an initial wound assessment was done on 01/29/2025, the day prior to R1 being sent to the hospital. The facility staff denied the allegation and reported turning R1 every two hours as instructed by hospice.

The information obtained during the Department’s investigation did not sufficiently support the allegation. While R1 did sustain pressure injuries during their stay at the facility, the investigation did not provide sufficient evidence to substantiate neglect/lack of care. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, copy of this report issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025

LIC9099 (FAS) - (06/04)

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