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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609700
Report Date: 12/23/2025
Date Signed: 12/23/2025 12:46:04 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.RO, 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
11/18/2025 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20251118091713
FACILITY NAME:BRILLIANT SENIOR CARE FACILITYFACILITY NUMBER:
197609700
ADMINISTRATOR:DAVTYAN, ANNAFACILITY TYPE:
740
ADDRESS:16246 VINTAGE STTELEPHONE:
(747) 529-4964
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 5DATE:
12/23/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:DAVTYAN, ANNA- LicenseeTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff provided inadequate information to resident's medical providers.
Staff provided inadequate information to resident's responsible party.
INVESTIGATION FINDINGS:
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At approximately 9:30 AM, Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit in response to the above-mentioned allegations. LPA met with Staff#1 (S1), who granted access to the facility. Entrance interview conducted.

LPA conducted a physical plant tour at 9:40 AM.

To investigate the allegations, on 11.24.2025, LPA interviewed the licensee, two (2) staff, and four (4) out of five (5) residents between 10:14 AM to 11:47 AM. Between 11:48 AM and 12:00 PM, LPA requested and reviewed copies of pertinent information, which included, but were not limited to, LIC 500 (Staff Roster), LIC 9020 (Client Roster), R1’s Physician’s report, Admission Agreement, Identification and Emergency Information, Appraisal Needs and Service Plan, and other documents relevant to the investigation.
Continue to LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
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-20251118091713
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER: 197609700
VISIT DATE: 12/23/2025
NARRATIVE
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Allegation #1: Staff provided inadequate information to resident's medical providers.

It was alleged that facility staff provided inadequate information about Resident #1 (R1) to the medical provider when they were admitted to the hospital. R1 was brought to the hospital via ambulance due to a UTI. Interview with licensee (S1) revealed that the emergency medical technician (EMT) requested copies of R1 records, and documents were given to the EMT. Interview with staff #2 (S2) revealed that they witness S1 rushing to make copies of R1’s records for EMT. Interviews with four (4) out of five (5) residents revealed that they have no issue with facility staff relaying and providing information to their medical providers. During licensing visits, LPA Ngo-Castaneda observed copies of the documents prepared for each resident to provide the medical providers and emergency personnel.

Based on the information, observation, and record review gathered during this, the allegation is deemed unsubstantiated.

Allegation #2: Staff provided inadequate information to resident's responsible party.

It was alleged that facility staff did not provide adequate information about R1 to their responsible party. During interviews with the licensee (S1), it was revealed that R1 is responsible for themselves, and no family members/ individual are responsible for R1. An interview with four (4) out of five (5) residents revealed that they have no issues with facility staff notifying their family and their responsible party regarding their care at the facility. A review of R1’s admission agreement, Emergency identification and other documents verified that R1 is self responsible and no other individual is noted as a responsible party.

Based on the information, observation, and record review gathered during this, the allegation is deemed unsubstantiated.

Exit interview conducted. Copy of this report issued

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2