197608349-3-28-2025-31-AS-TAGD-DFCPVY-20250402113954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 10/11/2024
Date Signed: 03/28/2025 10:23:55 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
08/19/2024 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20240819144755

FACILITY NAME:	ABBEY ROAD VILLA		FACILITY NUMBER:	197608349
ADMINISTRATOR:	MARINE KARAPETIAN		FACILITY TYPE:	740
ADDRESS:	14132 HUBBARD STREET		TELEPHONE:	(818) 837-0077
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	78	CENSUS: 71	DATE:	10/11/2024
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Marine Karapetian - Administator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not ensure medications are dispensed as prescribed to resident

INVESTIGATION FINDINGS:

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This report is being amended to rectify typographical and grammatical error. No change in findings.

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with Administrator Marine Karapetian and explained the reason for the visit.

LPA conducted physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 10:00 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and resident between 11:00 AM to 1:00 PM. Regarding the allegation that Staff do not ensure medications are dispensed as prescribed to resident, it was alleged that Resident #1 (R1) appeared to be over medicated when admitted to the hospital on 08/19/24. LPA's record review on 08/23/24 between 10:30 AM to 12:00 PM revealed that R1 has a medical condition that needs constant monitoring but does not necessarily need medication to be administered constantly. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

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-20240819144755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ABBEY ROAD VILLA	FACILITY NUMBER: 197608349
	VISIT DATE: 10/11/2024

NARRATIVE

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(continued from LIC 9099)

Further review also revealed that R1 needs only minimal assistance on medication management. LPA's interview with R1 revealed that R1 was being administered medication for R1’s medical condition every morning by a nurse but not on the day when R1 was hospitalized on the morning of 08/19/24. LPA's interview with two (2) staff on 08/23/24 confirmed that the care staff was about to clean and change R1 to get ready and bring R1 to the dining area for breakfast but noticed that R1 was not responsive as usual so they called 911 and brought R1 to the hospital. LPA's interview with Resident #2 (R2) who is the room mate of R1, today at 1:35 PM, also confirmed that R1 was administered medication by the nurse every morning but not on the day that R1 was last hospitalized in August.

Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC9099 (FAS) - (06/04)

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