197609995-9-25-2025-29-AS-KHEN-DLZUR6-20250930154812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609995
Report Date: 09/25/2025
Date Signed: 09/25/2025 03:20:01 PM

Unsubstantiated

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
09/18/2025 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20250918123856

FACILITY NAME:	HEART OF HOME SENIOR LIVING		FACILITY NUMBER:	197609995
ADMINISTRATOR:	MOVSESIAN, KAJO		FACILITY TYPE:	740
ADDRESS:	6425 NAGLE AVE		TELEPHONE:	(747) 247-2365
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91401
CAPACITY:	6	CENSUS: 5	DATE:	09/25/2025
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Kajo Movsesian - Licensee		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Resident was left in a soiled diaper
Resident is unable to communicate with staff due to language barrier

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced initial complaint visit for the above allegations. LPA arrived at 9:40AM and met with the Licensee Kajo Movsesian and explained the reason for the visit. Entrance interview conducted.

Beginning at 9:57AM, the LPA and Licensee conducted a brief tour to ensure the health and safety of the residents, and no immediate concerns were observed. Between 10:05AM and 11:24AM, the LPA interviewed four (4) residents, two (2) staff, and the Licensee. At 12:05PM, the LPA reviewed and obtained pertinent documents. The following was then determined:

Report Continued on LIC 9099-C

*Report amended due to missing signature

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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 3

Control Number 29-AS-20250918123856

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: HEART OF HOME SENIOR LIVING	FACILITY NUMBER: 197609995
	VISIT DATE: 09/25/2025

NARRATIVE

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Allegations: “Resident was left in a soiled diaper” and “Resident is unable to communicate with staff due to language barrier.”

It was reported that on 09/17/2025, emergency services responded to a 911 call from the facility with complaints of chest pain from Resident #1 (R1). R1 was observed to be in a soiled diaper that leaked through their shirt and mattress. It was also alleged that residents are unable to communicate with facility staff and staff were unable to provide emergency services information for the residents in care due to a language barrier. Interview with three (3) out of four (4) residents revealed they have not experienced being left in a soiled diaper for long periods of time. R1 reported that there were two (2) previous occasions that they believed they were not changed but was not certain about their answer. Resident #2 (R2) reported that they were unsure if they utilized an adult diaper. Resident #3 (R3) and Resident #4 (R4) reported having no issues with their diaper changes and that staff are attentive to their incontinence needs. Record review showed that two (2) out of five (5) residents require some assistance with toileting/incontinence needs while three (3) residents required full assistance. Staff #1 (S1) and Staff #2 (S2) reported that they conduct physical checks on residents often with diaper checks every two (2) to three (3) hours, and more if needed. S1 stated diapers are changed often, and in addition to routine checks, if staff smell a foul odor they will change the resident immediately. S2 stated some residents can utilize the bathroom or communicate to the staff if they are soiled. S2 also educated the more independent residents on how to change their own diapers, however, staff will continue to assist with changes as needed.

Residents reported that they had no issues with communication with staff. R3 stated S1 can sometimes have difficulty with communicating due to limited English. R3 and R4 stated that they communicate with S1 by repeating themselves and using hand gestures or signals for better understanding, to which S1 then successfully understands and can fulfill their requests. R1 described the staff as “ok” and R1 had no problems with staff communication. Residents had no overall complaints about the staff and their abilities for meeting resident needs. Interview with S1 was accomplished through the utilization of a translator app, however S1 was able to respond to the LPA’s questions with basic English.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250918123856

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: HEART OF HOME SENIOR LIVING	FACILITY NUMBER: 197609995
	VISIT DATE: 09/25/2025

NARRATIVE

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S1, S2, and the Licensee stated that S1 is the only staff who knows limited English, however, will have scheduled shifts with staff who are more fluent. In an emergency when 911 is dispatched, staff immediately notified the Licensee in which the Licensee will arrive at the facility within five (5) minutes or communicate with emergency services via telephone call. Although the Licensee is known to communicate with emergency services, S1 and S2 were knowledgeable in emergency procedures and were aware of where to access the residents’ information. Additionally, the Licensee stated that during an emergency, staff are instructed to not touch or move the residents which included pausing diaper changes, until emergency services evaluated the situation.

Although the allegations may have happened or are valid, there is not sufficient evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed UNSUBSTANTIATED at this time.

No deficiency related to the allegations were cited. Exit interview conducted. A copy of the report was reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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