197608349-6-18-2025-31-AS-TAGD-DNR2WU-20251124164606

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 06/18/2025
Date Signed: 06/18/2025 02:16:37 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
06/17/2025 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20250617131313

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:	06/18/2025
		UNANNOUNCED	TIME BEGAN:	09:23 AM
MET WITH:	Marine Karapetyan - Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Illegal eviction

Staff did not ensure that resident's dietary needs were met

Staff did not seek timely medical attention for resident

INVESTIGATION FINDINGS:

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

LPA conducted physical plant tour at 9:39 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 residents between 11:00 AM to 1:00 PM. Regarding the allegation of Illegal eviction, it was alleged that the Administrator is threatening Resident #1 (R1) with eviction. LPA's record review between 11:00 AM to 12:00 PM revealed that R1 was being evicted for non-payment and was issued an eviction letter on 04/25/25. LPA's interview with the administrator today at around 12:30 revealed that the administrator rescinded the eviction about a week later from issuance upon the intervention of the Assisted Living Waiver (ALW) staff with the verbal agreement that R1 will be relocated, R1 however still lives at the facility to date and not paying the right amount of rent every month. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

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-20250617131313

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: 06/18/2025

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Staff did not ensure that resident's dietary needs were met, it was alleged that dietary needs of R1 was not being met. LPA's record review today between 10:00 AM to 11:00 PM, revealed that R1 has only No Added Salt (NAS) dietary restriction on R1's diet and this was prominently displayed on the kitchen. LPA's interview with kitchen staff revealed that all residents with the dietary restriction is being provided to the kitchen and being updated regularly by the Administrator. Further interview also revealed that all the dietary restriction are being followed during preparation of their meals to abide by the said restriction with no exception.

Regarding the allegation that Staff did not seek timely medical attention for resident, it was alleged that Resident #2 (R2) was allegedly saw by R1 "sitting on the floor with R2's back propped up against R2's dresser" and staff did not call 911 until the next day. LPA's record review revealed that R2 did not fall and was hospitalized on 06/06/25 for shortness of breath (SOB) due to R2's medical condition. LPA's interview with staff also revealed that it was the nurse who visited R2 during routine visit who observed R2 having an SOB and sent immediately to the hospital via 911. Further review also revealed that R2 is still at the hospital to date.

Based on the information gathered during this visit, these 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: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

LIC9099 (FAS) - (06/04)

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