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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850216
Report Date: 05/09/2025
Date Signed: 05/09/2025 01:43:18 PM

Substantiated


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
05/08/2025 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20250508130427
FACILITY NAME:ELDERCARE HOMES, INC.FACILITY NUMBER:
195850216
ADMINISTRATOR:HEKIMYAN, LUIZAFACILITY TYPE:
740
ADDRESS:7754 COLDWATER CANYON AVENUETELEPHONE:
(818) 764-8545
CITY:N. HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 5DATE:
05/09/2025
UNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Luiza HekimyanTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff did not meet a resident's dietary needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint visit for the above allegation. LPA arrived to the facility at 09:54 AM. LPA met with facility staff who contacted the facility Administrator, Luiza Hekimyan, and the facility Assistant Administrator, Tina Arutyunyan, via telephone call. The Administrator and the Assistant Administrator arrived shortly after. Entrance interviews were conducted and the reason for the visit was explained.

During today’s visit, the LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted a file review for one (1) resident, collected copies of pertinent documentation, and conducted interviews with the Administrator, the Assistant Administrator, two (2) staff members, and three (3) residents between 10:00 AM. and 12:30 PM.

Continued on LIC-9099C
Substantiated
Estimated Days of Completion: 30
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
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 4
Control Number 29-AS-20250508130427
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: ELDERCARE HOMES, INC.
FACILITY NUMBER: 195850216
VISIT DATE: 05/09/2025
NARRATIVE
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The allegation of “Staff did not meet a resident's dietary needs” alleges that the facility did not adhere to the dietary restrictions of resident #1 (R1). LPA Byrne interviewed R1 who stated that they are lactose intolerant and facility staff are aware of this dietary restriction. R1 stated that they were given cereal with milk by staff #1 (S1) on the morning of 05/08/2025. R1 stated that as a result of consuming the cereal and milk the suffered an episode of diarrhea for a few hours. LPA interviewed S1 who admitted to giving R1 cereal with milk in the morning of 05/08/2025. S1 stated that they were aware that R1 cannot have milk due to their lactose intolerance. S1 stated that R1 had a total of three (3) bowel movements between 09:15 AM and 10:15 AM after being given cereal and milk. S1 stated that they informed the responsible party of R1 immediately and offered their apologies for the incident. LPA interviewed staff #2 (S2) who confirmed that R1 had 3 bowel movements on the morning of 05/08/2025. S2 stated that they assisted in changing R1 and described the bowel movements as normal. LPA interviewed the Administrator who stated that they were unaware of R1’s lactose intolerance or R1 being given milk with cereal. LPA requested that the Administrator submit an incident report to Community Care Licensing for this incident, the Administrator agreed to submit an incident report. LPA interviewed two (2) additional residents. One (1) resident interviewed, resident #2 (R2) had a dietary restriction. R2 stated that the facility adheres to their dietary needs. R2 had no concerns about the facility’s food service. Based on the information obtained during interviews there is sufficient evidence to support the allegation of “Staff did not meet a resident's dietary needs.” Therefore, the allegation is deemed Substantiated at this time.

The following deficiency was cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250508130427
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: ELDERCARE HOMES, INC.
FACILITY NUMBER: 195850216
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2025
Section Cited
CCR
87468.2(a)(5)
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87468.2 Additional Personal Rights of Residents...
(a) In addition...residents...shall have all of the following personal rights:
(5) To be served food... necessary to meet their nutritional needs.
This requirement is not met as evidenced by:
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Administrator agreed to conduct training with facility staff on the importance of adhering to the dietary needs of facility residents. Licensee will submit proof of training attendance to CCLD no later than POC due date.
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Based on interviews the licensee did not comply with the section cited above as one resident was served milk while being lactose intolerant which caused them to have 3 bowel movements in a 1 hour timeframe which poses a potential health risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC9099 (FAS) - (06/04)
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