<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850542
Report Date: 04/21/2025
Date Signed: 04/21/2025 05:35:14 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
04/18/2025 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20250418084125
FACILITY NAME:ROSE GARDEN SENIOR HOUSINGFACILITY NUMBER:
195850542
ADMINISTRATOR:TONOYAN, LILITFACILITY TYPE:
740
ADDRESS:7526 TROOST AVENUETELEPHONE:
(818) 601-3232
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 3DATE:
04/21/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lilit TonoyanTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not meet resident's medical needs.
Staff did not administer resident's medications as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 09:45 AM. LPA met with facility staff who contacted the facility Administrator Lilit Tonoyan. The Administrator arrived to the facility at approximately 10:15 AM the reason for the visit was explained and entrance interview was conducted.

During today’s visit LPA conducted a physical plant tour, reviewed three (3) resident files, three (3) staff files, conducted a medication audit for two (2) residents, and interviewed the Administrator, the Licensee, one (1) staff and two (2) residents between 10:00 AM and 02:30 PM.

Continued on LIC-9099C
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
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-20250418084125
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: ROSE GARDEN SENIOR HOUSING
FACILITY NUMBER: 195850542
VISIT DATE: 04/21/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The allegation of “Staff did not meet resident's medical needs.” alleges that the facility did not assist resident #1 (R1) in conducting a medical appointment with their physician. LPA interviewed R1 who revealed that recently they were supposed to have an in-person medical appointment with their physician earlier in the month. R1 revealed that they were unable to attend the appointment in-person due to issues in arranging the transportation. R1 stated that the visit was conducted via telephone call instead. LPA interviewed the Administrator who stated that R1’s doctor is in another city and family of R1 had not arranged transport to the medical appointment. Additionally, the Administrator revealed that during R1’s stay at the facility R1 has missed a total of two (2) appointments due to issues with arranging transportation. LPA reviewed R1’s admission agreement to the facility. LPA observed the following entry in the admission agreement, “Transportation-Responsible persons may and are encouraged to provide basic transportation. Facility may provide resident with transportation when responsible person or an alternative arrangement is unavailable, to be billed at a minimum of $30.00 per hour or any portion of an hour to cover driver and/or caregiver escort.” LPA informed that Administrator that per the signed admission agreement the facility agreed to provide transportation to medical appointments for R1. The Administrator expressed understanding and confirmed that they would assist residents in arranging transportation to future medical appointments. Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of “Staff did not meet resident's medical needs.” Therefore, the allegation is deemed Substantiated at this time.

The allegation of “Staff did not administer resident's medications as prescribed.” alleges that the facility did not administer R1’s medications as prescribed. LPA interviewed R1 who stated that they believe the facility is not administering all of their required medications. LPA reviewed R1’s hospital paperwork dated 04/07/2025. LPA observed R1’s hospital paperwork to contain prescriptions for seventeen (17) medications and one (1) medical device. LPA conducted a medication review for R1. R1’s centrally stored medication and destruction record sheet was observed to contain six (6) medications. LPA asked the Administrator where the rest of R1’s medications were. The Administrator stated that the family of R1 has not dropped off the remaining medications. The Administrator stated that the facility has been waiting for the family to obtain the medications and has not made an effort to get R1’s prescribed medications yet. The interview with the facility’s other resident did not reveal concerns with their medication administration. Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of “Staff did not administer resident's medications as prescribed.” Therefore, the allegation is deemed Substantiated at this time. Continued on LIC 9099C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250418084125
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: ROSE GARDEN SENIOR HOUSING
FACILITY NUMBER: 195850542
VISIT DATE: 04/21/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The following deficiencies were 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: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20250418084125
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: ROSE GARDEN SENIOR HOUSING
FACILITY NUMBER: 195850542
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2025
Section Cited
CCR
87465(a)(2)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care
(a) ... provide for assistance in obtaining such care...
(2) ...This includes transportation... the licensee shall do so directly or make arrangements for this service.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit a statement of understanding confirming that they will assist residents with their transportation needs to medical appointments. Licensee will submit their plan on how they will obtain transportation for R1 no later than POC due date.
8
9
10
11
12
13
14
Based on interview and record review the licensee did not comply with the section cited above as R1 has not been to two in-person medical appointments during their care at the facility which poses a potential health risk to clients in care.
8
9
10
11
12
13
14
Type B
05/05/2025
Section Cited
CCR
87465(a)(4)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care
(a) ...provide for assistance in obtaining such care, by compliance with the following:
(4) The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit proof that the 11 identified medications have arrived at the facility and are being given as prescribed no later than POC due date.
8
9
10
11
12
13
14
Based on interview and record review the licensee did not comply with the section cited above as R1 has not been receiving 11 medications that were perscribed by their physician which poses a potential health risk to clients in care.
8
9
10
11
12
13
14
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: 04/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4