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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609639
Report Date: 06/17/2025
Date Signed: 06/17/2025 03:00:05 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2024 and conducted by Evaluator Quoc Huynh
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20240501152453
FACILITY NAME:ANA'S RESIDENCE CARE FACILITYFACILITY NUMBER:
197609639
ADMINISTRATOR:ANNA ATAYANFACILITY TYPE:
740
ADDRESS:7747 VAN NOORD AVETELEPHONE:
(323) 688-3377
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 5DATE:
06/17/2025
UNANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Anna Atayan - LicenseeTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are not adequately trained.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit to deliver findings for the above allegation. LPA arrived at 1:37PM and met with the Licensee Anna Atayan and explained the reason for the visit.

On 05/05/2024, LPA Christine Yee conducted an initial unannounced complaint investigation visit. Beginning at 10:40AM, LPA Yee reviewed and obtained copies of five (5) residents' Identification and Emergency Information, Physician Reports, Appraisal/Needs and Services, and copies of the Staff training log dated from 2018 to 2023. Between 11:57AM and 12:32PM, LPA interviewed two (2) residents and the Licensee.

Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2024 and conducted by Evaluator Quoc Huynh
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20240501152453

FACILITY NAME:ANA'S RESIDENCE CARE FACILITYFACILITY NUMBER:
197609639
ADMINISTRATOR:ANNA ATAYANFACILITY TYPE:
740
ADDRESS:7747 VAN NOORD AVETELEPHONE:
(323) 688-3377
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 5DATE:
06/17/2025
UNANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Anna Atayan - LicenseeTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are unable to assist residents in care due to language barrier.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit to deliver findings for the above allegation. LPA arrived at 1:37PM and met with the Licensee Anna Atayan and explained the reason for the visit.

On 05/05/2024, LPA Christine Yee conducted an initial unannounced complaint investigation visit. Beginning at 10:40AM, LPA Yee reviewed and obtained copies of five (5) residents' Identification and Emergency Information, Physician Reports, Appraisal/Needs and Services, and copies of the Staff training log dated from 2018 to 2023. Between 11:57AM and 12:32PM, LPA interviewed two (2) residents and the Licensee.

Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 29-AS-20240501152453
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ANA'S RESIDENCE CARE FACILITY
FACILITY NUMBER: 197609639
VISIT DATE: 06/17/2025
NARRATIVE
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On 06/13/2025, LPA Huynh conducted an unannounced subsequent investigation visit. The LPA toured the facility at 11:26AM, reviewed staff and resident files beginning at 11:48AM, and obtained pertinent documents. Throughout the duration of the visit, LPA interviewed two (2) residents and two (2) staff along with the Licensee.

During today’s visit, the LPA and Licensee toured the physical plant areas at 1:40PM to ensure there are no health and safety hazards. Based on observations, interviews, and documentation gathered and reviewed, the following was then determined:

Allegation: “Staff are unable to assist residents in care due to language barrier”
It was alleged that residents and staff cannot communicate due to a language barrier and therefore staff is unable to assist residents with their needs. Interviews with four (4) Residents revealed that staff can understand and assist them with their requests. Resident #1 (R1) and Resident #2 (R2) stated that when staff do not understand their needs, the staff and residents would utilize their phone to assist in translating. R2 stated they only use a translator, or text the Licensee, when they have more complex requests such as meal preparations. Resident #3 (R3) stated staff can be slow to respond but can understand what they need assistance with. R3 also stated that if staff does not understand them, they would point/gesture to what they’re requesting. R2 would also assist R3 with communicating and expressed that Staff #1 (S1) understands R3’s needs very well. Interview with S1 and Staff #2 (S2) revealed that they understand English but have trouble speaking it. The interview was conducted with the Licensee who assisted with translating open-ended questions. Interview with the Licensee revealed that the facility’s staff know little English, however they are learning and can understand and are able to assist residents. The Licensee stated that staff and residents text them, along with the on-call Administrator, every minute of the day regarding residents’ needs. In emergencies, staff will notify the Licensee and Administrator, who live close by and can respond right away. Emergency services are called by the Licensee and the Administrator.

Report Continued on LIC 9099-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 29-AS-20240501152453
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ANA'S RESIDENCE CARE FACILITY
FACILITY NUMBER: 197609639
VISIT DATE: 06/17/2025
NARRATIVE
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Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

No deficiency for the above allegation was cited. Exit interview conducted. A copy of today’s report was reviewed and provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 29-AS-20240501152453
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ANA'S RESIDENCE CARE FACILITY
FACILITY NUMBER: 197609639
VISIT DATE: 06/17/2025
NARRATIVE
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On 06/13/2025, LPA Huynh conducted an unannounced subsequent investigation visit. The LPA toured the facility at 11:26AM, reviewed staff and resident files beginning at 11:48AM, and obtained pertinent documents. Throughout the duration of the visit, LPA interviewed two (2) residents and two (2) staff along with the Licensee.

During today’s visit, the LPA and Licensee toured the physical plant areas at 1:40PM to ensure there are no health and safety hazards. Based on observations, interviews, and documentation gathered and reviewed, the following was then determined:

Allegation: “Staff are not adequately trained”
It was alleged that staff were not sufficiently trained and do not know how to care and assist residents. Upon employment, staff are required to complete 40 hours of initial training before working directly with residents per regulation. The 40 hours of initial training can be transferred, however Dementia Care, Building and Fire Safety, Emergency Response, and Medication training cannot be transferred. Each year thereafter, staff are required to complete 20 hours of annual training with an additional 8 hours of Medication training. The annual 20 hours of training include: 8 hours of Dementia Care, 4 hours of Postural Support and Hospice Care as well as Restricted Health Conditions, and 8 hours of any General topics from the initial training.

Record review and interview revealed that Staff #2 (S2) was hired on 05/15/2025 and their initial 40 hours of training were transferred from a previous facility, however the non-transferrable training hours were not completed after employment. Staff #1 (S1), Staff #3 (S3), and Staff #4 (S4) met their initial 40 hours of training requirement. From 2023-2024, S1 and S3 received 2 hours of Medication training, therefore did not meet their annual Medication training requirement. From 2024-2025, S1 did not receive their annual Medication, Postural Support, Hospice Care, Restricted Health Conditions, and General training requirements. Additionally, S3 did not receive their annual Medication, Postural Support, Hospice Care, and Restricted Health Conditions training requirement. S4 received their annual 20 hours of training from 2023-2024.

Report Continued on LIC 9099-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 29-AS-20240501152453
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ANA'S RESIDENCE CARE FACILITY
FACILITY NUMBER: 197609639
VISIT DATE: 06/17/2025
NARRATIVE
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During record review, the LPA observed S1’s 1st aid/CPR certification expired on 02/05/2025 and the Licensee provided a renewed certification effective 06/13/2025. S1 was directly assisting residents for four (4) months without an updated certification, therefore the Licensee and S1 did not maintain their training requirement. Interviews with the staff and the Licensee revealed that all staff assist residents in administering medications, with the exception of S4 who does not directly assist residents.

Based on observations, interviews, and record review, the preponderance of evidence standard has been met, therefore the allegation is deemed SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency is cited (refer to LIC9099-D).

Exit interview conducted. A copy of the appeal rights and today’s report was reviewed and provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 29-AS-20240501152453
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ANA'S RESIDENCE CARE FACILITY
FACILITY NUMBER: 197609639
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2025
Section Cited
CCR
87411(c)
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87411 Personnel Requirements – General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69

This requirement is not met as evidenced by:
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The Licensee will have S2 complete their non-transferrable initial training and send proof to CCLD. The Licensee will review the training requirement regulations and send CCLD a written plan to implement the training requirements and specify the required hours and topics.
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above, as 1 staff did not complete their initial 40 hours of training and 3 staff did not meet the annual training requirements, which poses/posed a potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7