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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850571
Report Date: 06/03/2025
Date Signed: 06/03/2025 01:38:04 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
05/05/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20250505163541
FACILITY NAME:SWEET APPLE ASSISTED LIVINGFACILITY NUMBER:
195850571
ADMINISTRATOR:AVETISYAN, ARMINEFACILITY TYPE:
740
ADDRESS:6858 AMESTOY AVENUETELEPHONE:
(702) 601-2178
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY:6CENSUS: 5DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Armine AvetisyanTIME COMPLETED:
12:53 PM
ALLEGATION(S):
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Staff handled resident in a rough manner resulting in an injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to deliver the findings for the allegation listed above. LPA Urena was greeted by the Administrator Armine Avetisyan. The LPA explained the reason for the visit. LPA Urena and the Administrator conducted a brief tour of the facility

On 05/13/2025, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial complaint visit regarding the allegation listed above. LPA Urena conducted a brief tour the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. No physical plant concerns were observed at the time of the tour. The LPA interviewed the Administrator at 12:50 p.m. and asked for documents relevant to the investigation. The LPA interviewed five (5) out of six (6) residents, one staff and the administrator between 12:25 p.m. and 2:24 p.m. Continues on LIC 9099...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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 3
Control Number 29-AS-20250505163541
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: SWEET APPLE ASSISTED LIVING
FACILITY NUMBER: 195850571
VISIT DATE: 06/03/2025
NARRATIVE
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Staff handled resident in a rough manner resulting in an injury.

It is alleged that the staff handled a resident in a rough manner resulting in injury, and it is the concern of the reporting party (RP) that staff (S1) was rough with residents while assisting in transferring from one place to another. The residents’ interview revealed that S1 has been rough with them during the time they have been residing at the facility. The residents stated that S1 is rough while transferring from the bed, while waking them up and at other times of the day. The residents showed the LPA with hand gestures how S1 had been rough by poking at their chest while trying to wake them up, pushing the food table against their legs and causing bruises. Residents showed the LPA the bruises caused by the food table pushed against their legs. Furthermore, one resident stated that they were afraid to go to sleep because they feared that staff would attack them at night. LPA Urena reviewed residents’ records and observed that three out of six residents are non-ambulatory and may require assistance with transferring from bed to either a chair or to a walker. The LPA interviewed the staff about the allegation and the staff denied being rough or causing any injuries. The LPA interviewed the Administrator about the allegation and the Administrator stated that they were not aware of unprofessional or abusive behavior from the staff to residents.

Based on the information obtained through residents’ interviews, record review and observation of the bruises, there is sufficient evidence to prove the staff handled residents in a rough manner. Therefore, the allegation is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 9099-D).



Exit interview was conducted. Copy of the report and Appeal Rights were issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250505163541
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: SWEET APPLE ASSISTED LIVING
FACILITY NUMBER: 195850571
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/10/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1(a)(3)-Personal Rights of Residents in All Facilities-(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3)To be free from punishment, humiliation, intimidation, abuse, or other withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidence by:
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POC: The Licensee stated that they let go of S1 on 05/13/2025, and agreed to train all staff on personal rights and spend more time observing the staff and having frequent conversatiosn with residents in care.
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Based on interviews, the licensee did not comply with the above cited section when S1 inappropriately handled residents, which posed an immediate health and safety 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3