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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 05/13/2025
Date Signed: 05/14/2025 04:32:06 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
11/08/2024 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20241108102704
FACILITY NAME:ABBEY ROAD VILLAFACILITY NUMBER:
197608349
ADMINISTRATOR:MARINE KARAPETIANFACILITY TYPE:
740
ADDRESS:14132 HUBBARD STREETTELEPHONE:
(818) 837-0077
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:78CENSUS: 68DATE:
05/13/2025
UNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Marine Karapetyan - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff neglect led to resident sustaining pressure injuries

Staff did not meet resident's medical needs in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator Marine Karapetyan and explained the reason for the visit.

LPA conducted physical plant tour at 9:28 AM, requested copies of facility documents relevant to the investigation at 10:02 AM, reviewed records between 10:10 AM to 12:30 PM and interviewed staff between 12:30 AM to 1:30 PM. Regarding the allegation that Staff did not meet resident's medical needs in a timely manner, it was alleged that Resident #1 (R1) was transported to Southern California Hospital due to a possible infection of R1's foot and had to be treated for a serious foot infection. LPA's record review today between 10:10 AM to 12:30 PM revealed that R1 was admitted at the facility on 07/03/23 and was hospitalized on 02/09/24 and did not come back to the facility, during R1's stay at the facility R1 was hospitalized for various medical complaint nine (9) times from 07/06/23 to 02/09/24, aside from regular monthly check up at the facility by R1's Primary Care Physician (PCP). (continued on LIC 9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
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 2
Control Number 31-AS-20241108102704
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: 05/13/2025
NARRATIVE
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(continued from LIC 9099)

Further review also revealed that there are times that R1 refused regular medical checkup at the facility and was referred to a podiatrist to see R1's foot but refused to see the Podiatrist on 02/08/24, R1 was hospitalized the next day (02/09/24) for this reason. Being a non-medical facility, the facility sends R1 to hospital and inform R1's PCP for all of R1's medical concern on a regular basis.

Regarding the allegation that Staff neglect led to resident sustaining pressure injuries, it was alleged that R1 was admitted to the hospital and had to be treated for bed sores on her buttock area. LPA's record review revealed that immediately prior to hospitalization, R1 was at the pain clinic for an outpatient consult. During this encounter, Clinic doctors did not notice any break or injury on R1's skin and was "unremarkable" during this visit. LPA's interview with three (3) care staff during this visit revealed that no one among the three (3) care staff noticed any break or injury on R1's buttocks or any pressure area on R1's skin.

Based on the information gathered during this and prior visit, the allegations are 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: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2