195850590-10-10-2025-29-AS-KLOZ-DMYR79-20251031124558

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850590
Report Date: 10/10/2025
Date Signed: 10/10/2025 05:13:00 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
10/03/2025 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20251003141134

FACILITY NAME:	NIRVANA GARDENS ASSISTED LIVING		FACILITY NUMBER:	195850590
ADMINISTRATOR:	GABUZYAN, CHRISTINA		FACILITY TYPE:	740
ADDRESS:	15801 HART ST.		TELEPHONE:	(323) 925-6629
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY:	6	CENSUS: 5	DATE:	10/10/2025
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Christina Gabuzyan		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not provide proper notice of rate increase.

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. The staff contacted the Administrator Christina Gabuzyan, and the LPA explained the reason for the visit. The Administrator was unable to come to the facility at the time of the visit, consequently the LPA explained and read the allegation over the phone.

LPA Urena interviewed the Administrator, and requested records pertinent to the investigation.
On the allegation that the Staff did not provide proper notice of rate increase, it is the concern of the Reporting Party (RP) that the resident (R1) was being illegally evicted, because the facility Administrator did not provide R1’s responsible party with a legal notice of an increase in rent, with a possibility of eviction if the responsible party could not pay the increase in the rent fee by 10/07/2025. The LPA interviewed the RP on 10/10/2025 at approximately 8:49 a.m.
Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20251003141134

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: NIRVANA GARDENS ASSISTED LIVING	FACILITY NUMBER: 195850590
	VISIT DATE: 10/10/2025

NARRATIVE

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Per the RP, a public agency received an eviction letter for R1 from the facility Administrator; however, the letter was not signed. Per the RP neither the R1 nor their responsible party reported that they would be evicted. The LPA interviewed R1’s responsible party, and the responsible party denied receiving an eviction letter from the facility Administrator. Per the responsible party, they had a discussion with the Administrator during the admission agreement meeting that the Administrator agreed to accept R1 for a minimum rent payment, with the agreement that a rent increase would take place after three months of the admission of R1, the responsible party accepted the agreement and signed the agreement dated on 04/07/2025. Furthermore, the party responsible stated that they have not received an eviction letter after the tree months. The responsible party stated that they were very happy with the services being provided to R1 at the facility, happy with the staff and the Administrator, and had no concerns. The interview with the Administrator revealed that they admitted R1 on 04/07/2025, after receiving a referral from LA Care. The Administrator stated that they were told that they could get additional funding from other sources to cover for the difference in fees, given that the responsible party for R1 could only pay a minimum fee, with a $3,000 difference to pay the full $5,000 dollar fee. An admission agreement and a contract document was created at the time of the admission of R1, where R1’s responsible party agreed to the conditions of the admission. Furthermore, the Administrator stated that they have been working with R1’s responsible party to get the additional funds to cover for the full rate of the stay at the facility, and that they do not plan on evicting R1. Record review revealed that in addition to the admission agreement, a Resident Responsible Party Agreement was created and was accepted and signed by R1’s responsible party.

Although the allegation may have happened or is valid, based on the interviews, and record review there is not sufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

The Administrator was not present to sign the repot and assigned the facility's representative Melany Gabuzyan to sign the report.
Interview exit was conducted. A copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025

LIC9099 (FAS) - (06/04)

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