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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850586
Report Date: 10/15/2025
Date Signed: 10/15/2025 06:48:02 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
10/11/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20251011205324
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: 5DATE:
10/15/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Satenik AlajanyanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff provided unprescribed medication to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegation listed above. The LPA was greeted by staff and the staff contacted the Administrator on the phone. The LPA spoke with the Administrator on the phone Satenik Alajanyan and explained the reason for the visit.
The Administrator stated they would come to the facility within 30 minutes.

LPA Urena, along with the staff, toured 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.

LPA Urena interviewed staff at approximately 10:30 a.m. and Administrator at approximately 11:30 a.m. and requested records pertinent to the investigation.

Continues on LIC 90999C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
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-20251011205324
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: 10/15/2025
NARRATIVE
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On the allegation that staff provided unprescribed medication to residents (R1) in care; it is the concern of the reporting party that staff used medication which was not prescribed to R1, and that the medication belonged to another resident.
To investigate the allegation, LPA Urena interviewed the RP on 10/13/2025 at approximately 11:47 a.m. Per the RP, the staff administered medication (two dosages of Lorazepam) which could have had severe complications given that R1 has dementia. LPA Urena interviewed R1’s responsible party and the interview revealed that staff informed them that on 10/10/2025, R1 had been constantly crying and agitated the night before and early morning and was disturbing other residents. The staff explained that they were desperate to calm down R1 and gave two tablets of the Lorazepam to R1. The interview with staff revealed that R1 had been getting anxious late at night, and during this time, R1 kept going into the other residents’ rooms, bothering them and not letting them sleep. This incident took place the night of 10/09/2025; it started late at around 11:00 p.m. and continued till next morning of 10/10/2025 until approximately 2:00 a.m.; this is when the staff administered the two pills during separate times because the first pill did not calm R1 down. The staff stated that they had informed the Administrator of the concern with R1’s agitation and bothering the other residents. On the morning of 10/10/2025, staff had a phone conversation with R1’s responsible party and informed them that they had given R1 the Lorazepam. Furthermore, the staff stated that they, and the responsible party for R1 had a three-way telephone conversation with R1’s primary physician at approximately 10:00 a.m. on the same day, and the staff explained to the physician what had happened the previous night . The interview with the Administrator revealed that they were aware of the incident. Record review revealed that R1’s primary physician prescribed two medications (Buspirone 5mg. 2xd, and Trazodone 50mg. as needed) to address the concerns of insomnia and agitation. The medications were filled on 10/10/2025, and per the Administrator the facility received them on 10/14/205. Staff started assisting with medications on the same day the medication was delivered.

Based on the information obtained through interviews and record review, the allegation that staff provided unprescribed medication to R1, 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).

Citations were issued. Interview exit was conducted. A copy of the report and Appeal Rights were issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20251011205324
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2025
Section Cited
CCR
87465(a)(2)
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87465 (a)(2)- Incidental Medical and Dental Care A plan for incidental medical and dental care shall be developed by
each facility. The plan shall Encourage…medical…care and provide for assistance in obtaining such care, by
compliance with the following: (1) the licensee shall arrange, or assist in arranging, for medical.. care appropriate to the conditions and needs of residents. (2) The licensee shall provide assistance in meeting necessary
medical…needs… This requirement is not met as evidenced by:
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Administrator agreed to provide medication training to staff from a qualified professional by the POC date and Administrator will review the cited regulation for understanding and submit proof to the department and LPA via email.
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Based on information, and record review, the administrator did not assist in getting the appropriate care for R1’s agitation
and crying, and by staff administering unprescribed medication to R1, which poses an immediate health and safety 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
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