197608349-4-6-2025-31-AS-TAGD-DFLSYV-20250410141810

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 04/06/2025
Date Signed: 04/06/2025 01:57:18 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.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
09/17/2024 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20240917160355

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: 67	DATE:	04/06/2025
		UNANNOUNCED	TIME BEGAN:	12:04 PM
MET WITH:	Anush Karapetyan - Staff		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Resident sustained multiple fractures while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegation. LPA met with staff Anush Karapetyan who called the Administrator Marine Karapetian and explained the reason for the visit. Ms. Karapetian designated the staff to sign the report.

On 09/17/24, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted by Community Care Licensing Division’s Investigations Branch (IB) and assigned to IB investigator Christine Ferris.

On 09/18/24 at 9:23 AM, LPA initiated the complaint visit. LPA interviewed staff and residents and obtained copies of the facility records relevant to the investigation.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2025

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-20240917160355

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: 04/06/2025

NARRATIVE

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(continued from LIC 9099)

During the course of the investigation, Investigator Ferris interviewed the administrator, staff, and residents on different dates and times on 10/17/24 and 11/18/24. IB Investigator Ferris also reviewed hospital records on 11/12/24, Los Angeles Police Department (LAPD)’s records on 10/07/24 and 11/07/24.

Regarding the allegation resident sustained multiple fractures while in care, it was alleged that due to staff neglect, Resident #1 (R1) was punched in the face by Resident #2 (R2) sustaining injury and fracture on R1’s face and hip fracture due to R1’s eventual fall. Investigator Ferris’ record review of LAPD’s report revealed that R2 was arrested immediately after the incident at the facility but upon receipt of the facility surveillance video footage of the incident, the Deputy District Attorney rejected to file a case against R2 due to lack of sufficient evidence and eventually released R2 back to the facility. Investigator Ferris’ and LPA’s review of the facility surveillance video footage revealed that R1 and Resident #3 (R3) were together around the corner of the facility along the hallway and upon seeing R2 walking towards them, R1 charged R2 and punched R2 in the face. R2 reacted by punching R1 back (in the face) causing R1 to fall to the ground. R2 then walked away while R3 stayed with R1 until staff arrived and called 911. LPA’s record review on 03/29/25 also revealed that R1 and R2 were able to perform their own Activities of Daily Living (ADL)s including but not limited to toileting, managing own cash resources, feeding and with minimal assistance on dressing/grooming and bathing.

Based on the information gathered during the course of the investigation, 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: 04/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2025

LIC9099 (FAS) - (06/04)

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