197603652-4-21-2025-31-AS-NGID-DGQTVE-20250516150346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603652
Report Date: 04/21/2025
Date Signed: 04/21/2025 05:08:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250417115746

FACILITY NAME:	AMBASSADOR GARDEN		FACILITY NUMBER:	197603652
ADMINISTRATOR:	SOFI DRUKER		FACILITY TYPE:	740
ADDRESS:	7324 CANBY AVENUE		TELEPHONE:	(818) 705-3404
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	158	CENSUS: 68	DATE:	04/21/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Sofi Druker, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff illegally evicted resident in care.
Staff did not issue refund to resident or resident's authorized representative.

INVESTIGATION FINDINGS:

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At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit to the above facility. LPA met with the staff Ezabella Litmanovich and the Administrator Sofi Druker was contacted and arrived shortly after. LPA disclosed the reason for the visit.

During course of the investigation, interviews and record review were made. At 9:35 AM LPA requested resident and staff roster. At 9:45 AM, LPA requested copies of pertinent information which include, but not to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, and etc., relevant to the investigation. At 9:55 AM, LPA conducted a physical plant tour. Between 10:20 AM. – 2:25 PM., LPA conducted an interview with the Administrator, two (2) MedTechs, two (2) staff, Resident #1 (R1) Physician Office Staff, R1's family, and eight (8) out of eight (8) residents. On 04/18/2025, LPA conducted a Community Care Licensing facility file review of the facility’s plan of operation for eviction procedures and policy on refunds.
Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
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)

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Control Number 31-AS-20250417115746

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMBASSADOR GARDEN	FACILITY NUMBER: 197603652
	VISIT DATE: 04/21/2025

NARRATIVE

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Staff illegally evicted resident in care.
It was alleged that the facility evicted Resident #1 (R1) illegally. To investigate this allegation LPA conducted an interview with the Administrator who denied the allegation. Administrator informed LPA that per R1’s family request a non-emergency ambulance was called to take R1 to the hospital on 04/07/2025. LPA was informed that R1 was not going to return to the facility and the Administrator refunded the prorated monthly payment to R1’s family. LPA contacted R1’s family member who confirmed that R1 still remains in the hospital and as of today date no discharge orders been received. Lastly, during today’s visit LPA observed that R1’s medication and other personal belongings were still present at the facility and R1’s room was still vacant. Therefore, based on interviews, record review, and LPA’s observation this allegation is deemed Unsubstantiated at this time.

Staff did not issue refund to resident or resident's authorized representative.
It was alleged that the facility refused to refund the full amount of $2,133 to R1's family for R1's stay at the facility from 04/04/2025 to 04/07/2025. To investigate this allegation LPA reviewed and obtained copies of pertinent facility and R1’s records. Furthermore, LPA conducted an interview with the Administrator who informed LPA that upon R1's family request for a refund the Administrator contacted the corporate office to issue a check payable to R1's family in the prorated amount of $1,852.48. Lastly, the check was mailed to R1's family on 04/15/2025. Based on Safety Code 1569.652 and Assembly Bill 261 a refund is to be issued within 15 days after the personal property of a resident has been removed. Therefore, based on the information obtained, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted, and a copy of this report was issued

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
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)

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