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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850537
Report Date: 04/29/2025
Date Signed: 04/29/2025 03:39:47 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
04/28/2025 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20250428083513
FACILITY NAME:ALLIANCE HEALTH RCFE INCFACILITY NUMBER:
195850537
ADMINISTRATOR:GOLFEIZ, SARAFACILITY TYPE:
740
ADDRESS:23601 CANZONETTELEPHONE:
(818) 426-1136
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 6DATE:
04/29/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sara GolfeizTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are sleeping in common areas
Staff does not ensure resident's door is in good repair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct an initial complaint investigation for the allegations listed above 10:00AM. Upon arrival, LPA met with staff and Administrator Sara Golfeiz who arrived at 10:12AM. Entrance interview conducted.

During today's visit, LPA interviewed three (3) residents and attempted interviews with two (2) residents between 10:02AM-11:35AM, interviewed two (2) staff members and Administrator between 10:20AM-10:55AM, conducted a physical plant tour between 10:12AM-11:12AM, reviewed and obtained copies of pertinent documents relevant to the investigation between 10:35AM-10:50AM, and discussed allegations with Administrator at 11:40AM.

Report Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
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-20250428083513
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: ALLIANCE HEALTH RCFE INC
FACILITY NUMBER: 195850537
VISIT DATE: 04/29/2025
NARRATIVE
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It was alleged that Staff #1 (S1) sleeps on the couch in the family room at nights. LPA observed the family room to be free of S1’s belongings and other items that suggest S1 primarily sleeps in the family room. However, three (3) of three (3) resident interviews, S1, and Administrator confirmed that S1 sleeps on the couch during the night shift. S1 temporarily shares a room with a resident but prefers to sleep in the common area instead as it is more central to the other residents. Administrator has obtained approved building permits for a staff room addition which will begin construction in the near future. Administrator stated that a signal system can be installed so that S1 can sleep in the shared bedroom while also having a method to be contacted by other residents for assistance. Based on interviews, the allegation “Staff are sleeping in common areas” is deemed SUBSTANTIATED at this time.

It was further alleged that the fire door in bedroom #4 does not self-close. LPA inspected the door at 11:11AM and observed that the door closer on the top of the door was not attached to the door frame and that the molding and framing on the top of the door was loose and a potential hazard. Administrator confirmed that the door closer was installed around January 2025 and stopped functioning two (2) months after installation. Administrator stated that the door closer and door framing will get fixed during the facility’s renovation and staff room construction, as the current molding cannot support the door closer. Based on observation and interview, the allegation “Staff does not ensure resident's door is in good repair” is deemed SUBSTANTIATED at this time.

The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Administrator designated staff Christian Trambulo to sign the report.



Exit interview conducted. Appeal rights and a copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20250428083513
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: ALLIANCE HEALTH RCFE INC
FACILITY NUMBER: 195850537
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2025
Section Cited
CCR
87307(a)
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87307 Personal Accommodations and Services (a) ...The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility...This requirement is not met as evidenced by:
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Administrator stated that S1 will sleep in their shared bedroom and not in common areas until the staff room is constructed. Administrator plans to implement a signal system so that S1 can assist resident's requests without having to sleep in a central common area. POC cleared during visit.
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Based on interviews, the licensee did not comply with the section cited above as Staff #1 (S1) sleeps on the couch in the family room which poses a potential health, safety, and personal rights risk to persons in care.
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Type B
05/06/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being...
This requirement is not met as evidenced by
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Administrator stated that the door closer will be repaired during the facility's upcoming renovation. Administrator will submit proof of the planned service request to CCLD by 05/06/2025.
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Based on observation and interview, the licensee did not comply with the section cited above as the door in bedroom #4 did not have a functioning door closer which poses a potential health, safety, and personal rights risk to persons 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: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
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
04/28/2025 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20250428083513

FACILITY NAME:ALLIANCE HEALTH RCFE INCFACILITY NUMBER:
195850537
ADMINISTRATOR:GOLFEIZ, SARAFACILITY TYPE:
740
ADDRESS:23601 CANZONETTELEPHONE:
(818) 426-1136
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 6DATE:
04/29/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sara GolfeizTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Resident faucets do not deliver hot water
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct an initial complaint investigation for the allegations listed above 10:00AM. Upon arrival, LPA met with staff and Administrator Sara Golfeiz who arrived at 10:12AM. Entrance interview conducted.

During today's visit, LPA interviewed three (3) residents and attempted interviews with two (2) residents between 10:02AM-11:35AM, interviewed two (2) staff members and Administrator between 10:20AM-10:55AM, conducted a physical plant tour between 10:12AM-11:12AM, reviewed and obtained copies of pertinent documents relevant to the investigation between 10:35AM-10:50AM, and discussed allegations with Administrator at 11:40AM.

Report Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
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-20250428083513
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: ALLIANCE HEALTH RCFE INC
FACILITY NUMBER: 195850537
VISIT DATE: 04/29/2025
NARRATIVE
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It was alleged that the sink in the hallway resident bathroom does not deliver hot water. LPA ran the hot water in the bathroom between 10:14AM-10:19AM until the water measured at 106.2 degrees Fahrenheit. LPA observed that it took five (5) minutes for the water in the sink to reach the required range of 105-120 degrees F. Staff stated that it takes a while for the water to get hot. Residents interviewed stated they had access to hot water and had no concerns of hot water access. Administrator stated that a new water heater has been purchased and is in the garage until it can get installed during the facility’s upcoming renovation. Based on interviews and observation, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Resident faucets do not deliver hot water” is deemed UNSUBSTANTIATED at this time.

Administrator designated staff Christian Trambulo 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: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6