197609891-3-26-2026-31-AS-MGFS-DSVQ5K-20260406115202

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609891
Report Date: 03/26/2026
Date Signed: 03/26/2026 01:20:55 PM

Substantiated

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
12/31/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20251231143108

FACILITY NAME:	ANGELES ASSISTED LIVING		FACILITY NUMBER:	197609891
ADMINISTRATOR:	ASATRYAN, YULIYA		FACILITY TYPE:	740
ADDRESS:	15942 BAHAMA STREET		TELEPHONE:	(818) 891-4183
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 5	DATE:	03/26/2026
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Yuliya Asatryan- Administrator		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Resident sustained severe pressure injury due to staff neglect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent visit to this facility to deliver findings. LPA met with facility administrator (S1) Yuliya Asatryan, who granted access to the facility.

On 12/31/2025, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding above allegation. Initial investigation was conducted by Department’s representative on 1/2/2026. Department’s representative requested the following documents: staff roster (LIC 500), resident roster (LIC 9020), resident #1 (R1) physician’s report, appraisals needs and service plan, identification and emergency information (LIC 501), home health care plan, and other documents. LPA reviewed resident’s records from 3:35 PM until 3:45 and requested copies. LPA took a tour of the physical plant with the assistance of the administrator at 2:00PM. LPA interviewed four (4) residents and three (3) staff from 2:40 PM until 3:30 PM.

Continue to LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

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 3

Control Number 31-AS-20251231143108

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: ANGELES ASSISTED LIVING	FACILITY NUMBER: 197609891
	VISIT DATE: 03/26/2026

NARRATIVE

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On 1/9/2026, LPA requested R1’s Home Health medical records.

Regarding allegation: Resident sustained severe pressure injury due to staff neglect.

It is alleged that on 12/28/25 R1 was admitted to the hospital with a stage 3 sacral wound. R1 was admitted to the facility on 10/25/25, record review, physician report, revealed that R1 did not have any skin breakdown. R1 was no longer present at the facility during LPA visit and was still at the hospital. All of the residents interviewed during the investigation did not address any concerns regarding their care at the facility. Home health records review revealed R1 had developed pressure injuries on their sacral, groin, heel- right and left, and buttocks. Wound started developing on December 1, 2025. An interview with staff revealed repositioning assistance was provided to avoid or relief pressure injuries, S2 and S3 provided repositioning. Interview with R1 family revealed that they are happy with the care given by the facility and were not aware that R1 should be at a higher level of care.

Record reviews revealed that the staff S2 and S3 are trained and were following home health instructions on how to care for R1’s wounds . A review of home health records revealed R1 was admitted to home health on November 18, 2025. On December 1, 2025 a sacral wound stage 1 was noted by home health. On December 8, 2025 home health noted sacral wound as a stage 2, additional wound was noted to the groin area as a stage 1. On 12/12/25 , Supportive Health Group (wound specialist) noted R1 had a stage 3 pressure injuries to the left (L) buttock, which measured 6.0 cm x 5.5 cm x 0.1 cm and stage 1 pressure injuries to the right and left heel. Although R1 was receiving home health care services for wound care with wound care specialist from home health and staff were providing required assistance, pressure injuries were not healing and develop into stage 3 wound on 12/12/25. On 12/28/25, R1 was then brought to the hospital for a stage 3 wound. Facility staff retained R1 from 12/12/25 to 12/28/25 with a stage 3 wound. Therefore, the allegation is substantiated.

Based on observation, interviews, and record review, there is sufficient evidence. Therefore the allegation is deemed substantiated California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099-D .

An immediate Civil Penalty of $500.00 will be issued during this visit due to neglect/lack of care by providing care to R1 with a prohibited health condition. An additional civil penalty may be assessed at a later time based on Health and Safety Code 1569.49.

An exit interview was conducted. Appeal rights a copy of the report, LIC 9099D, were provided.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20251231143108

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: ANGELES ASSISTED LIVING	FACILITY NUMBER: 197609891
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/26/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/27/2026 Section Cited CCR 87615(a)(1)	1 2 3 4 5 6 7	Persons who require health services for or have a health condition, including, but not limited to, Stage 3 and 4 pressure injuries, shall not be admitted or retained in a residential care facility for the elderly. This requirement was not met, as evidenced by Based on observation medical records received	1 2 3 4 5 6 7	The administrator will provide written plan of action explaining steps they will take to avoid similar issues from happening again. Written statement should verify that a Licensed consultant will be hired to provide additional training to address this section of the regulation. A copy of the training log, the training topic, and attendance shall be submitted to the Licensing agency by POC 3.27.2026.
	8 9 10 11 12 13 14	and interviews with staff, confirming R1 sustaining multiple stage 3 wounds and stayed at the facility.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

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