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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850216
Report Date: 10/23/2025
Date Signed: 10/23/2025 03:03:22 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
03/19/2025 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20250319084954
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: 6DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Olha NikolaienkoTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Resident was admitted to hospice without consent.
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 01:28 PM. LPA met with facility staff who contacted the facility Assistant Administrator, Tina Arutyunyan, via telephone call. The Assistant Administrator was unable to come to the facility during today's visit. Entrance interview was conducted and the reason for the visit was explained.

On 03/11/2025, the LPA initiated the investigation and conducted a physical plant tour, collected copies of pertinent documents, and conducted interviews with the Administrator, the Assistant Administrator, and one (1) staff member between 10:35 AM. and 12:30 PM. On 04/11/2025, the LPA conducted a subsequent visit and conducted a physical plant tour, conducted a medication review for four (4) residents, and conducted interviews with the Administrator, the Assistant Administrator, five (5) residents, and three (3) witnesses between 09:30 AM. and 01:15 PM.
Continued on LIC 9099C.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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 6
Control Number 29-AS-20250319084954
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: 10/23/2025
NARRATIVE
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During today’s visit, the LPA conducted a brief physical plant tour and delivered findings for the above allegation between 01:28 PM. and 02:50 PM.

The allegation of “Resident was admitted to hospice without consent” alleges that Resident #1 (R1) was transferred to a Hospice company without their or their Durable Power of Attorney (DPOA)’s consent. LPA reviewed R1’s file and observed hospice admission paperwork for the Hospice company in question. LPA observed R1’s name and a signature on the admission documents. LPA interviewed R1 and provided them the document for review. R1 confirmed that the signature and the initials on the document did not match their own. LPA interviewed DPOA who confirmed that they did not give consent for R1 to be enrolled in the Hospice company. LPA interviewed staff #1 (S1), the facility Administrator, and the Assistant Administrator. All staff interviewed denied requesting the transfer of R1 onto the Hospice company but were unsure why R1 was enrolled with the company. Based on interviews with witness #1 (W1) LPA confirmed that due to R1’s condition, R1 was mentally unable to consent to signing up for hospice care at the time they were enrolled with the Hospice company. LPA confirmed that at the time R1 was enrolled with the Hospice company, R1 was under the care and supervision of the facility. LPA reviewed documentation from the Department of Health & Human Services which stated that as of 04/07/2025 the Hospice company has had their Medicare provider agreement involuntarily terminated and is no longer operating. Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of “Resident was admitted to hospice without consent.” Therefore, the allegation is deemed Substantiated at this time.

The Assistant Administrator was unable to come to the facility during today's visit but has designated S1 to sign this report on their behalf. This report was read to the Assistant Administrator via telephone call. 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: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20250319084954
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: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2025
Section Cited
CCR
87468.2(a)(7)
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87468.2 Additional Personal Rights...
(a) ...shall have all of the following personal rights:
(7) To fully participate in planning their care, ... and involve persons of their choice in this planning...
This requirement is not met as evidenced by:
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Assistant Administrator agreed to submit a signed statement of understanding confirming that they understand the importance of residents participating in the planning of their care and confirming that they will review future documents for signs of falsified information/foargaries of signatures...
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Based on interviews and record review the licensee did not comply with the section cited above as R1 was fraduantly enrolled with a hospice company with a falsified signature while under the care and supervision of the facility which posed a potential personal rights risk to persons in care.
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... Assistant Administrator agreed to submit the statement to CCLD no later than POC due date.
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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: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
03/19/2025 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20250319084954

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: 6DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Olha NikolaienkoTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff make residents stay in bed all day
Staff falsified resident records
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 01:28 PM. LPA met with facility staff who contacted the facility Assistant Administrator, Tina Arutyunyan, via telephone call. The Assistant Administrator was unable to come to the facility during today's visit. Entrance interview was conducted and the reason for the visit was explained.

On 03/11/2025, the LPA initiated the investigation and conducted a physical plant tour, collected copies of pertinent documents, and conducted interviews with the Administrator, the Assistant Administrator, and one (1) staff member between 10:35 AM. and 12:30 PM. On 04/11/2025, the LPA conducted a subsequent visit and conducted a physical plant tour, conducted a medication review for four (4) residents, and conducted interviews with the Administrator, the Assistant Administrator, five (5) residents, and three (3) witnesses between 09:30 AM. and 01:15 PM. Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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 6
Control Number 29-AS-20250319084954
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: 10/23/2025
NARRATIVE
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 During today’s visit, the LPA conducted a brief physical plant tour and delivered findings for the above allegations between 01:28 PM. and 02:50 PM.

The allegation of “Staff make residents stay in bed all day” alleges that facility staff do not assist residents with leaving their beds and require that they remain in bed throughout the day. LPA interviewed five (5) residents of the facility. Residents interviewed had no concerns about staff not assisting them in transferring from their bed. Additionally, no residents interviewed stated that they are required by staff to remain in bed during the day. Resident #1 (R1) stated that they have a walker in their room and ask staff for assistance with utilizing the device but have been asked to build leg strength before attempting to use the walker. Interviews with R1’s Durable Power of Attorney (DPOA), Staff #1 (S1), and R1 revealed that during early 2025 R1 was not physically well enough to move about the facility with significant staff assistance. S1 stated that they attempted to move R1 from their bed to the dining table for meals but R1 was unwilling and unable to move so meal service to R1’s bed was provided until R1 recovered. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff make residents stay in bed all day.” Therefore, the allegation is deemed Unsubstantiated at this time.

The allegation of “Staff falsified resident records” alleges that R1’s records contained falsified signatures. LPA reviewed R1’s file and observed R1’s physician report to be signed by an emergency room doctor. LPA contacted the phone number listed, and the representative was able to confirm that the doctor did work in their emergency room. All other required documentation located in R1’s file appeared to be signed by DPOA and a facility representative. LPA observed R1’s hospice admission paperwork for Hospice. LPA observed a signature on the admission document but interviews with R1 and DPOA revealed that this signature did not match R1’s signature. LPA interviewed S1, the Administrator, and the assistant Administrator, all of whom denied falsifying the signature. Although the signature on R1’s hospice paperwork was confirmed to be falsified there is insufficient evidence to prove facility culpability as it remains unclear who falsified the signature. LPA reviewed documentation from the Department of Health & Human Services which stated that as of 04/07/2025 the Hospice company has had their Medicare provider agreement involuntarily terminated and is no longer operating. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff falsified resident records.” Therefore, the allegation is deemed Unsubstantiated at this time.

Continued on LIC 9099C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20250319084954
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: 10/23/2025
NARRATIVE
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The Assistant Administrator was unable to come to the facility during today's visit but has designated S1 to sign this report on their behalf. This report was read to the Assistant Administrator via telephone call. Exit interview was conducted and a copy of the report was provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6