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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609980
Report Date: 03/18/2026
Date Signed: 03/18/2026 05:26:33 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
03/11/2026 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20260311081619
FACILITY NAME:AMY'S PARADISE HOME OF ANGELS INC.FACILITY NUMBER:
197609980
ADMINISTRATOR:EMMA AVETISYANFACILITY TYPE:
740
ADDRESS:11950 ROSCOE BLVDTELEPHONE:
(310) 913-6161
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 6DATE:
03/18/2026
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Meri TarposhyanTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff mismanage residents' medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted a complaint visit for the above allegation. LPA arrived to the facility at 09:44 AM. LPA met with facility staff member Emma Elazyan (S1) who contacted the facility administrator Emma Avetisyan. The Administrator informed LPA that they were unable to come to the facility at the time of the visit. Facility representative Meri Tarposhyan (S2) arrived to the facility at approximately 11:50 AM. Entrance interview was conducted and the reason for the visit was explained.

During today’s visit, the LPA conducted a brief physical plant tour, a medication and file review for six (6) residents, obtained copies of pertinent documentation, and conducted interviews with S1, S2, and one (1) resident between 09:55 AM and 02:00 PM.

Continued on LIC 9099C.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026
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 29-AS-20260311081619
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: AMY'S PARADISE HOME OF ANGELS INC.
FACILITY NUMBER: 197609980
VISIT DATE: 03/18/2026
NARRATIVE
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The allegation of “Staff mismanage residents' medication.” Alleges that facility staff mismanage resident’s medications and that facility staff inappropriately administer sleeping pills to residents. LPA conducted a medication review for six (6) residents. LPA interviewed Staff #1(S1) and Staff #2 (S2). Both staff members denied administering any medications not prescribed by a physician, including sleeping aids, to residents. LPA observed two (2) resident’s Centrally stored medication and destruction record sheets (CSMDRs) to contain inaccurate records of the resident’s prescribed medications. Additionally, during the audit of resident’s medications LPA observed a total of twenty three (23) medications across six (6) residents to have errors in the medication count. LPA and S2 observed the CSMDRs for six (6) residents and confirmed that the amount of medications remaining in the bottles did not match the amount of medications that should be left based on the recorded start date and medication administration instructions. The resident interviewed did not have concerns with the administration of medications at the facility. LPA did not observe evidence of unprescribed sleeping pills being administered to residents but did observe evidence of medication mismanagement. Based on interviews and record review there is sufficient evidence to support the allegation of “Staff mismanage residents' medication.” Therefore the allegation is deemed Substantiated at this time.

The facility Administrator was unable to come to the facility to sign this report but has designated S1 to sign on their behalf. This report was read to the Administrator via telephone call.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D): Exit interview conducted and copy of the report was issued and appeal rights provided
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260311081619
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: AMY'S PARADISE HOME OF ANGELS INC.
FACILITY NUMBER: 197609980
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/19/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care
(a) ... by compliance with the following:
(4) The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:
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Administrator agreed to conduct an immediate training with all staff handling resident medications covering best practices for medication administration and to submit proof of the completed training to CCLD no later than POC due date.
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Based on observation, record review and interview the licensee did not comply with the section cited above as twenty three medications across six residents had errors in the medication count which poses an immediate health 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3