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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850586
Report Date: 06/19/2025
Date Signed: 06/19/2025 06:25:25 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
06/11/2025 and conducted by Evaluator Erica Mosley
COMPLAINT CONTROL NUMBER: 29-AS-20250611115806
FACILITY NAME:ALL STAR LIVING INCFACILITY NUMBER:
195850586
ADMINISTRATOR:ALAJANYAN,SATENIKFACILITY TYPE:
740
ADDRESS:8123 PASO ROBLES AVETELEPHONE:
(818) 802-0866
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY:6CENSUS: 6DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Iuliia Palchikova - Caregiver TIME COMPLETED:
06:35 PM
ALLEGATION(S):
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Staff did not prevent resident from leaving the facility unassisted
Staff did not notify resident's responsible party of the relocation of resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erica Mosley conducted an initial 10-day complaint visit to investigate the above listed allegations. Upon arrival approx at 9:30 am, LPA Mosley was greeted by Staff Iuliia Palchikova who called the Administrator to inform them of the visit. The Administrator was unable to attend and designated staff Iuliia Palchikova to sign the report. LPA met with caregiver Iuliia Palchikova and the reason for the visit was explained. Entrance interview conducted.

On 06/11/2025, the Department received a complaint regarding the following allegations, Staff did not prevent resident from leaving the facility unassisted and Staff did not notify resident's responsible party of the relocation of resident. LPA and staff toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations.

Report continued on LIC 9099-C PAGE 2...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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-20250611115806
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: ALL STAR LIVING INC
FACILITY NUMBER: 195850586
VISIT DATE: 06/19/2025
NARRATIVE
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(PAGE 2) Report continued from LIC-9099-C...
During today’s visit, starting at 9:30 a.m. LPA and staff conducted a physical plant tour to ensure there are no immediate health and safety concerns and facility is in compliance with Title 22 Regulations, at 9:35 a.m. conducted a brief telephonic interview with the Administrator and reconducted the telephonic interview at 11:35 a.m. starting at 9:57 a.m. conducted in-person interviews with one (1) staff member / care giver, starting at 10:15 a.m. conducted in person interviews with three (3) residents and two (2) family members who were visiting, starting at 10:42 a.m. conducted a file review, and obtained copies of pertinent documents relevant to the investigation, At 11:28 a.m. two (2) attempted phone calls and voicemail were left for the facility office staff, starting at 12:26 p.m. conducted telephonic interviews with two (2) relocation site facility Administrators.

On the allegation Staff did not prevent resident from leaving the facility unassisted it is the concern of the Reporting Party (RP) that approx. around June 2025 Resident #1 (R1) had wandered out the facility. To investigate this complaint, on 06/13/25 at 1:36 p.m., 06/18/2025 at 8:30 a.m. LPA conducted a telephonic interview with the Los Angeles County Public Guardian (LACPG) on 06/17/2025 at 3:29p.m. conducted a telephonic interview with Family Member (FM) of R1, 06/19/25 starting at 9:35 a.m. conducted a brief telephonic interview with the Administrator and reconducted the telephonic interview at 11:35 a.m. starting at 9:57 a.m. conducted in-person interviews with one (1) staff member / care giver, starting at 10:15 a.m. conducted in person interviews with three (3) residents and two (2) family members / visitors, who were visiting a resident, starting at 10:42 a.m. conducted a file review, and obtained copies of pertinent documents relevant to the investigation, at 11:28 a.m. two (2) attempted phone calls and voicemails were left for the facility office staff. Telephonic interview with LACPG revealed that on 06/10/2025 they were informed that R1 was wandering however no specific details were given or provided. Interview with FM revealed that they are unaware of R1 leaving the facility unattended or unassisted. Interview with the Administrator revealed that R1 was only at the facility for two (2) to three (3) days max and in that time R1 wandered around the facility grounds however never wandered out of the facility. Interview with caregiver revealed that R1 was briefly at the facility one (1) to two (2) days and wandering around the kitchen in desire to cook food. R1 never left the facility unassisted by staff. R1 remained on the facility grounds supervised.
Report continued on LIC 9099-C PAGE 3...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250611115806
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: ALL STAR LIVING INC
FACILITY NUMBER: 195850586
VISIT DATE: 06/19/2025
NARRATIVE
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(PAGE 3) Report continued from LIC-9099-C...
Interviews with residents revealed that they are unfamiliar with R1 however recall hearing the name but no concrete information could be provided with certainty. Residents have never seen any of the other residents wander out the facility unattended or without staff knowledge. The staff would not allow the residents to leave the facility unattended. Interview with family visitors revealed that they have not witnessed any of the residents leave the facility unattended. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff did not prevent resident from leaving the facility unassisted is deemed unsubstantiated at this time.

On the allegation Staff did not notify resident's responsible party of the relocation of resident it is the concern of the of the Reporting Party (RP) that approx. around June 4th -8th 2025 Resident #1 (R1) was relocated to a facility in Hemet, Riverside County without informing the family. To investigate this complaint, on 06/13/25 at 1:36 p.m., 06/18/2025 at 8:30 a.m. LPA conducted a telephonic interview with the Los Angeles County Public Guardian (LACPG), on 06/17/2025 at 3:29p.m. conducted a telephonic interview with Family Member (FM) of R1,on 06/19/25 starting at 9:35 a.m. conducted a brief telephonic interview with the Administrator and reconducted the telephonic interview at 11:35 a.m. starting at 9:57 a.m. conducted in-person interviews with one (1) staff member / care giver, starting at 10:15 a.m. conducted in person interviews with three (3) residents and two (2) family members who were visiting, starting at 10:42 a.m. conducted a file review, and obtained copies of pertinent documents relevant to the investigation, At 11:28 a.m. two (2) attempted phone calls and voicemail were left for the facility office staff, starting at 12:26 p.m. conducted telephonic interviews with two (2) relocation site facility Administrators. Telephonic interview with LACPG revealed that on 06/10/2025 they were informed that R1 had been transferred to another facility for the safety of the resident. LACPG asked the facility if they had notified the family of the relocation of R1 and was informed by the facility to contact the family directly. Interview with FM revealed that they have do not have any authority, power of attorney (POA) conservatorship or signing rights for R1. FM is unfamiliar and unaware if R1 was at the facility or not, however was under the impression that R1 was rejected by the facility. FM called the facility and was informed that they did not have any resident with R1’s name. Interview with the Administrator revealed that R1 had been dropped off at the facility, exact date unknown without any knowledge or prior approval.

Report continued on LIC 9099-C PAGE 4...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20250611115806
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: ALL STAR LIVING INC
FACILITY NUMBER: 195850586
VISIT DATE: 06/19/2025
NARRATIVE
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(PAGE 4) Report continued from LIC-9099-C...
R1 arrived during the evening with nothing, no paperwork, documents or contact information for family. Administrator facilitated the relocation of R1 to a facility in Hemet, Riverside County. On 06/10/2025 Administrator was contacted by LACPG for the whereabouts of R1. Administrator informed LACPG that R1 was transferred, and they had no contact information for R1. Interview with caregiver revealed that R1 was briefly at the facility one (1) to two (2) days the exact date is unknown. R1 was dropped off by a transportation service from Kaiser with out any prior approval. R1 arrived with a green bag containing medications, change of clothing and paperwork that gave instructions on medications. The paperwork provided did not contain any information for R1, it did not have any contact information, or the list of medications R1 was on. The following day R1 was transferred to the facility in Hemet. Interviews with residents revealed that they are unfamiliar with R1 however recall hearing the name but no concreate information could be provided with certainty on R1. Interview with family visitors revealed that they are unaware and unfamiliar with R1 and have no knowledge of R1. Interview with Hemet facility Administrator (HFA) reveled that R1 had been dropped of at their facility on 06/04/2025 with no paperwork or belongings other than a LIC 602 Physician Report and a Kaiser face sheet with no contact information on it. HFA was later contacted by Adult Protective Services (APS) who provided more information regarding R1 and at that time provided contact information. R1 was transferred back to Kaiser with the knowledge of LACPG and FM for proper placement of R1. Interview with relocation site (RS) revealed that R1 was transferred to their facility on 06/17/2025 with a discharge summary. R1 is under the care and supervision of a licensed facility with LACPG and FM knowledge of their whereabouts. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur due to facilities not having any contact information or proper information for R1's family, LACPG, or emergency contact. Therefore, the allegation of Staff did not notify resident's responsible party of the relocation of resident is deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report and appeal rights provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4