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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850537
Report Date: 07/23/2025
Date Signed: 07/23/2025 03:40:05 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
02/13/2025 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20250213143506
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:
07/23/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sara GolfeizTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Resident's previous admission agreement is not being upheld
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegation listed above 10:45AM. Upon arrival, LPA met with staff and Administrator Sara Golfeiz who arrived at 11:03AM. Entrance interview conducted.

During today's visit, LPA conducted a brief physical plant tour at 10:47AM, interviewed two (2) staff and one (1) resident between 10:51AM-02:50PM, and reviewed and obtained copies of pertinent documents between 11:10AM-11:25AM. During the initial visit on 02/19/2025, LPA conducted a brief physical plant tour, conducted interviews with two (2) staff members, three (3) residents, and attempted an interview with one (1) resident, reviewed and obtained copies of pertinent documents relevant to the investigation, and discussed allegations with Administrator.

REPORT CONTINUED ON LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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-20250213143506
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: 07/23/2025
NARRATIVE
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It was alleged that the facility was not upholding Resident #1 (R1)’s admission agreement that R1 signed upon admission. LPA reviewed R1’s admission agreement signed and dated 11/17/2020 for the now-closed facility Eden Garden “C”, INC. (facility #197603977). The facility underwent a change of ownership (CHOW) which went into effect on 01/15/2025. R1 was admitted under the initial facility’s house rules and policies, which included a pet-policy allowing pets and R1’s dog. The house rules and policies of the current facility has a no-pet policy and no cameras allowed in resident rooms. R1 was admitted under an agreement that allowed them to have their pet and a pet camera in their room to monitor their dog when away from the facility. R1 was told that they were no longer allowed to have their pet or their pet camera. However, R1 was grandfathered into the current facility with the initial facility’s policies. R1 did not sign the current facility’s admission agreement due to the no-pet and no-camera policy and was told by the Administrator that their pet was no longer allowed to reside in the facility despite having a physician’s order for their emotional support animal (ESA). At this time, there are no regulations regarding ESAs or service animals in facilities. However, per regulation, residents have the right to refuse to sign the new admission agreement, meaning that the old admission agreement needs to be upheld. On 02/07/2025, R1 was issued an eviction notice based on the premise that they “have not signed the required admission agreement, which is necessary document for continued residency at this facility.” The Department reviewed this eviction notice and deemed it unlawful. Licensee was notified on 02/07/2025 that the eviction notice shall not be in effect as it does not fall under eviction criteria of CCR Title 22 Section 87224. The Administrator rescinded this notice on 02/19/2025 during LPA’s initial visit. LPA explained that residents cannot be forced/coerced into signing documents they do not want to, and that the facility must respect and uphold the admission agreement R1 initially signed. LPA further explained that licensees have the right to determine their own pet policy and camera policy as those are up to their discretion and Licensees have the right to not accept prospective residents with pets/cameras. However, the facility cannot attempt to evict R1 or tell them to relocate their pet due to new policies after a CHOW. Based on interview and record review, the allegation “Resident's previous admission agreement is not being upheld” is deemed SUBSTANTIATED at this time.

Administrator was unable to stay for the remainder of the visit and designated staff Christian Trambulo to sign the report. LPA delivered report telephonically to Administrator.

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


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: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20250213143506
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: 07/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2025
Section Cited
CCR
87468.2(a)(3)
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(a) ...residents...shall have all of the following...: (3) To be encouraged and assisted in exercising their rights...as residents...Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. This requirement is not met as evidenced by:
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On 02/19/2025, licensee rescinded the eviction notice issued to R1 for refusing to sign the new admission agreement. Licensee agreed to submit a statement of understanding of the section to CCL by 08/06/2025.
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Based on interview and record review, the licensee did not comply with the section cited above as R1's right to refuse to sign the new admission agreement was not free from coercion and their previous agreement was not upheld. This posed a potential personal rights risk to residents 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: 07/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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
02/13/2025 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20250213143506

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:
07/23/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sara GolfeizTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff did not provide proper notice of rent increase
Unlawful eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegation listed above 10:45AM. Upon arrival, LPA met with staff and Administrator Sara Golfeiz who arrived at 11:03AM. Entrance interview conducted.

During today's visit, LPA conducted a brief physical plant tour at 10:47AM, interviewed two (2) staff and one (1) resident between 10:51AM-02:50PM, and reviewed and obtained copies of pertinent documents between 11:10AM-11:25AM. During the initial visit on 02/19/2025, LPA conducted a brief physical plant tour, conducted interviews with two (2) staff members, three (3) residents, and attempted an interview with one (1) resident, reviewed and obtained copies of pertinent documents relevant to the investigation, and discussed allegations with Administrator.

REPORT CONTINUED ON LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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-20250213143506
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: 07/23/2025
NARRATIVE
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It was alleged that Administrator increased Resident #1 (R1)’s rate by $200 without proper 60-day notice. Administrator stated that they got a notification that SSI was increased (PIN 24-13-CCLD) by around $100 effective 01/01/2025. Residents were informed on 01/01/2025 about the increase but it was not charged until February 2025. Administrator issued a 60-day notice for the $200 increase to R1’s rent stating the reason as a “prior admission discount as not being applicable” and a $100 rate increase for “SSI/Medicare.” R1 confirmed the $200 discount from previous licensee which made R1’s monthly rate less than the SSI payment standard for basic services. All licensees were notified that effective 01/01/2025, the payment schedules for SSI/SSP recipients will be increased, meaning that the amount that licensees can charge for basic services a month increased. The amount was increased to $1420.07. Section 87507(g)(4) of the California Code of Regulations, Title 22, states “(g) Admission agreements shall specify the following: (4) Modification conditions, including the requirement for the provision of at least 60 days prior written notice to the resident of any rate or rate structure change, or as soon as the licensee is notified of SSI/SSP rate changes.” Section 1569.655(c) of the Health and Safety Code states “(c) If a licensee increases rates for a recipient under the State Supplementary Program for the Aged, Blind and Disabled, described in Article 5 (Commencing with Section 12200) of Chapter 3 of Part 3 of Division 9 of the Welfare and Institutions Code, the licensee shall meet the requirements for SSI/SSP rate increases, as prescribed by law.” Health and Safety Code Section 1569.655(a) was also updated to require no less than 90 days’ prior written notice to residents regarding rate increases effective 01/01/2025 instead of a 60-day notice. However, a 90-day notice is not required for SSI/SSP rate increases as those are determined statewide. A 90-day notice was required and was issued by the Administrator for the removal of the discount that was issued by the previous licensee. LPA reviewed R1’s bank statements to confirm that R1 receives enough SSI/SSA to afford the increased standard for basic services. LPA also confirmed that R1 was not being charged more than $1420.07, the basic services rate allowed for SSI recipients. Based on interviews and record review, 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 sufficient evidence to prove the alleged violation did or did not occur, therefore the above allegation “Staff did not provide proper notice of rent increase” is deemed UNSUBSTANTIATED at this time.

Report Continued on LIC9099-C.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20250213143506
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: 07/23/2025
NARRATIVE
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It was further alleged that the Administrator was evicting R1 for failure to sign the admission agreement. On 02/07/2025, R1 was issued an eviction notice based on the premise that they “have not signed the required admission agreement, which is necessary document for continued residency at this facility.” The Department reviewed this eviction notice and deemed it unlawful. Licensee was notified by LPA on 02/07/2025 that the eviction notice shall not be in effect as it does not fall under eviction criteria and that R1 shall be informed that the notice is void. The Administrator rescinded this notice on 02/19/2025 during LPA’s initial visit. LPA explained that residents cannot be forced/coerced into signing documents they do not want to, and that the facility must respect and uphold the admission agreement R1 initially signed. LPA further explained that the facility cannot attempt to evict R1 for exercising their personal right to refuse. While an unlawful eviction notice was issued on 02/07/2025, R1 was not unlawfully evicted, and the notice was rescinded on 02/19/2025. Based on interviews and record review, 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 sufficient evidence to prove the alleged violation did or did not occur, therefore the above allegation “Unlawful eviction” is deemed UNSUBSTANTIATED at this time.

Administrator was unable to stay for the remainder of the visit and designated staff Christian Trambulo to sign the report. LPA delivered report telephonically to Administrator.

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

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6