195850306-1-27-2025-29-AS-KHEN-DDEV66-20250130150900

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850306
Report Date: 01/27/2025
Date Signed: 01/27/2025 03:26:17 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
12/30/2024 and conducted by Evaluator Angela Barutyan

COMPLAINT CONTROL NUMBER: 29-AS-20241230093006

FACILITY NAME:	AAA JERUSALEM STARS		FACILITY NUMBER:	195850306
ADMINISTRATOR:	SOHEILA NOROOZI		FACILITY TYPE:	740
ADDRESS:	5945 CAPISTRANO AVE		TELEPHONE:	(818) 888-1706
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 5	DATE:	01/27/2025
		UNANNOUNCED	TIME BEGAN:	03:13 PM
MET WITH:	Karyna Deputativa		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not provide resident with proper notification prior to fee increase

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation with the purpose of delivering findings for the allegation listed above at 03:13PM. LPA met with staff. Administrator Kristina Adamyan was unable to arrive for the visit. Reason for the visit was explained.

During the initial visit on 12/30/2024, LPA conducted a brief physical plant tour, conducted interviews with two (2) staff members and four (4) residents, reviewed and obtained copies of pertinent documents relevant to the investigation, and discussed allegation with Administrator Adamyan.

It was alleged that Resident #1 (R1) was being evicted from the facility as R1 was unable to pay the $250 rent increase given with one-month notice. Interviews with staff and R1 did not support R1 being evicted. No eviction notice was reported to the Department and evidence of a notice was not observed. Report Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

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-20241230093006

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 JERUSALEM STARS	FACILITY NUMBER: 195850306
	VISIT DATE: 01/27/2025

NARRATIVE

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Interviews with staff and R1 supported that R1’s agreed-upon rate at admission was $1200 on 04/29/2022, but Administrator verbally agreed to a lower rate upon R1’s request. LPA reviewed records and observed the monthly rate in the admission agreement to be $4200, of which $1200 is from SSI and $3000 is from Medi-Cal. Administrator stated that R1 informed them on 12/30/2024, that R1 will be moving to a homeless shelter as they cannot afford rent. Administrator offered to lower R1’s rate to $800 and transfer R1 to a shared room at their other facility, which R1 also confirmed with LPA during interview. R1 further confirmed that their rate was informally lowered upon request and that they were offered a rate as low as $600. While rates were changed without the required notice, the changes were made informally and were decreased so that R1 could make their payments, not increased. R1’s agreed-upon rate in their signed admission agreement is $1200, and Administrator did not increase above this rate without the proper notice required. LPA interviewed three (3) other residents and reviewed records; no evidence of the allegation was observed. LPA held a discussion with the Administrator about regulations surrounding rate changes and informed Administrator to properly document and notify rate increases. Health and Safety Code section 1569.655(a) states “if a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives…”. As rates were not increased from the rate in R1’s admission agreement, a 60-day prior notice is not required in this scenario. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation “Staff did not provide resident with proper notification prior to fee increase” is deemed UNSUBSTANTIATED at this time.

Administrator telephonically designated staff Karyna Deputativa to sign the report.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025

LIC9099 (FAS) - (06/04)

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