195850179-10-31-2025-29-AS-KHEN-DMZ6ZS-20251031211538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850179
Report Date: 10/31/2025
Date Signed: 10/31/2025 05:36:17 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
08/30/2024 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240830140921

FACILITY NAME:	YMZ ASSISTED LIVING		FACILITY NUMBER:	195850179
ADMINISTRATOR:	DURGARYAN, REBEKA		FACILITY TYPE:	740
ADDRESS:	6206 KLUMP AVENUE		TELEPHONE:	(818) 358-2955
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 6	DATE:	10/31/2025
		UNANNOUNCED	TIME BEGAN:	01:37 PM
MET WITH:	Hasmik Baklajyan, Designated Staff		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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1. Staff hit resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent complaint visit to deliver the findings of the investigation based on the information received during the interviews and documents that were previously provided and was let into the home by Gulshair Iusupova, Staff. Rebeka Durgaryan, Administrator was contacted by staff but she did not The reason for today’s visit was provided.

On 9/6/24, Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced 10-day complaint investigation visit to the facility above. The LPA met with facility staff member Ada Bozkurt, at 03:42 PM and explained the purpose of the visit. Facility staff contacted the facility administrator Rebeka Durgaryan who arrived at the facility at 04:20 PM. Entrance interview conducted and the reason for the visit was explained.

continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

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-20240830140921

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: YMZ ASSISTED LIVING	FACILITY NUMBER: 195850179
	VISIT DATE: 10/31/2025

NARRATIVE

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On 9/6/24, Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced 10-day complaint investigation visit to the facility above. The LPA met with facility staff member Ada Bozkurt, at 03:42 PM and explained the purpose of the visit. Facility staff contacted the facility administrator Rebeka Durgaryan who arrived at the facility at 04:20 PM. Entrance interview conducted and the reason for the visit was explained.

During the 9/6/24 visit, starting at 04:23 PM, the LPA conducted a physical plant tour. The LPA also conducted interviews with residents, staff, and administrator between 4:29 PM and 4:40 PM and obtained copies of pertinent facility records. At this time, further investigation is needed. An LPA will follow up at a later date to continue the investigation. Exit interview conducted and a copy of the report printed.

On 10/28/25, Licensing Program Analyst (LPA) Christine Yee conducted a subsequent complaint visit to continue the investigation for the above allegation and erroneously indicated in the report generated that she was there to deliver the findings of the investigation conducted entirely by Veronica Padilla, Investigator with the Investigation Bureau. LPA Yee was let into the home by Shazada Zholdoshova, Staff. Staff contacted the Administrator to advise of LPA Yee's visit. Per telephone contact with the Administrator at 1:36pm, she advised LPA that she was sick and could not conduct the visit. LPA met with Hasmik Baklajyan, Designated Staff. The reason for today’s visit was provided.

On the visit conducted on 10/28/25, LPA Yee conducted a telephone interview with the Administrator to clarify the information previously provided as the staff could not locate Resident #1's file for review. Per the Administrator, she will email LPA Yee the documents later today. Due to time constraints and the lack of records, it has been determined that further investigation is needed before a finding could be made for the above allegation. Exit interview was conducted and a copy of this report was provided.

The documents requested on 10/28/25 were emailed to LPA Yee by Rebeka Durgaryan, Administrator, during today’s visit. Per information received to date, regarding the allegation that Staff hit resident in care, the investigation revealed from interview conducted with Rebeka Durgaryan, she vehemently denies that any

continued on LIC9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240830140921

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: YMZ ASSISTED LIVING	FACILITY NUMBER: 195850179
	VISIT DATE: 10/31/2025

NARRATIVE

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of her staff hit residents. Per information provided by interview conducted with witnesses, the family were told that the swelling on the right side of the resident’s face was that Resident #1, fell out of their wheelchair and hit the wall on 8/24/24. Allegedly the fall was witnessed by an unknown staff. Per the Administrator, there were no witnesses to any falls because there were no falls. Per the second interview conducted with the Administer on 10/28/25, she indicated that this incident happened a year ago and does not remember what happened but stated that Resident #1 did not fall. She did state that Resident #1 was highly anxious and very aggressive, had mental issues and per the family, the resident had been abused by their spouse, based on the resident’s fearful reaction to staff and everyone at the facility. Per the Administrator, Resident #1 would hit their hand on the arm of the wheelchair and would hit the bed rail with their hand and head. Per the Administrator, the resident messed up the facility.

Per the Administrator, on morning of 8/24/24, she was informed by Staff #1 that Resident was observed with a small bruise on the lower lip. Resident #1, diagnosed with dementia, could not explain how the bruise was sustained. On 8/29/24, Resident #1 was sent to the hospitalized for high blood pressure. Per the Administrator, she was present at the facility, and she was the one who called 911. Per the Administrator, Resident #1, was not observed with bruising, swelling or any injury to the face on the day of the hospitalization. Resident #1 was only observed with a little blue bruise on the lower lip on 8/24/24. The resident had a history of high blood pressure and was discharged from the hospital to the facility on 8/20/24, without any medications. Per the Administrator, the bruise was caused by the resident’s behavior. Per interviews conducted with staff, they indicated that they do not hit residents and do not have any issues with them. Per interviews conducted with residents, they all stated that the staff take good care of them and treat them fine. The residents also state that they have not seen any staff abuse any residents. During the investigation, LPA Yee was not able to identify anyone at the facility that could confirm that Resident #1 was hit by a staff member to sustain the facial swelling or the bruise to the lip. Per information provided by the

continued on LIC9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240830140921

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: YMZ ASSISTED LIVING	FACILITY NUMBER: 195850179
	VISIT DATE: 10/31/2025

NARRATIVE

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Reporting Party, the resident’s facial injuries were also checked by emergency room personnel during the visit on 8/29/24 for high blood pressure. Emergency room personnel could not conclusively state that the injury was the result of an assault or a fall or how the swelling was caused. Due to the lack of witnesses to the incident, there is insufficient evidence to support the allegation that staff hit a resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur

Exit interview was conducted.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

LIC9099 (FAS) - (06/04)

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