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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610111
Report Date: 01/27/2025
Date Signed: 01/27/2025 04:47:52 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
09/04/2024 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20240904133101
FACILITY NAME:CALIFORNIA STATE HEALTH GROUP LLCFACILITY NUMBER:
197610111
ADMINISTRATOR:ANDRANIK KAPIKYANFACILITY TYPE:
740
ADDRESS:9526 SALOMA AVETELEPHONE:
(818) 810-9339
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 5DATE:
01/27/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Andranik Kapikyan- AdministratorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator qualification.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda, Leizl DeLa Cerra, and Nadia Shahbazian conducted an subsequent complaint visit to the facility to investigate the above allegations. LPAs met with designee staff member, Isiah Phiri (S2) and was advised about the visit. Staff called administrator, Andranik Kapikyan, arrived at 9:35 AM; and was advised the reason of the visit.

An entrance interview was conducted.

Today's investigation involved interviews with the administrator and staff. LPAs also conducted a physical plant inspection of the facility at 9:24 AM to ensure the health and safety of the residents and a review of records. At 11 AM on 11.7.2024, LPA Ngo-Castaneda requested the resident and staff roster. During the investigation, interviews and record reviews were made.

Continue to LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
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-20240904133101
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: CALIFORNIA STATE HEALTH GROUP LLC
FACILITY NUMBER: 197610111
VISIT DATE: 01/27/2025
NARRATIVE
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 Between 10:15 and 10:45 AM, LPAs interviewed the staff and four (4) out of five (5) residents.

Allegation #1: Administrator qualification

It was specifically purported that the facility administrator deducted a portion of salary for staff #1(S1) and gave it to staff #2(S2) to resolve an agreement regarding an employee placement fee between the two employees.

LPA conducted a facility file review for hiring practices. There is no employee hiring and or placement fee policy indicated in the plan of operation. LPA requested check issued by administrator and dated 06.2024 and 08.2024 signed by Administrator. The check shows that staff (S1) was paid $500 less than their normal pay. On 1.27.2025, LPA requested staff payroll ledger for review, however, was unsuccessful in obtaining the information.

Interview with S2 indicated that there was an agreement with S1 that $1500 was to be paid to S2 as a staff placement fee. An interview with the administrator revealed that they were aware of the issue the staff was dealing with and did not get involved. The Administrator stated S1 had a salary deduction for the period of dates because they took a few days off from work.

Therefore, based on interviews and review of documentation presented there is insufficient information to support this allegation. The allegation Administrator qualification is UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2