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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610177
Report Date: 04/09/2025
Date Signed: 04/09/2025 04:35:03 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.ASC, 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
03/28/2025 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20250328130540
FACILITY NAME:ANNA'S HOME & PARADISEFACILITY NUMBER:
197610177
ADMINISTRATOR:ARMENYAN, ANNAFACILITY TYPE:
740
ADDRESS:23463 HAYNES STTELEPHONE:
(323) 660-0001
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 5DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Anna MalkhasyanTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Resident sustained a pressure injury due to lack of care from staff
INVESTIGATION FINDINGS:
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At approximately 4:25 p.m. on 04/09/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 04/01/25 and conducted a record review of pertinent records at 8:45 a.m. including but not limited to an admission agreement, medical assessment, and care plan, toured the facility at 9:00 a.m., and interviewed the administrator over the phone at 9:15 a.m. and staff and residents between 9:30 a.m. and 10:00 a.m. LPA conducted a record review of medical records at 2:00 p.m. on 04/08/25 and interviewed Visitor #1 (V1) at 2:15 p.m. on 04/08/25 and Resident #1 (R1) at 3:45 p.m. on 04/08/25. Today, LPA toured the facility inside and out at 4:30 p.m.

Regarding the allegation "Resident sustained a pressure injury due to lack of care from staff" it was alleged R1’s pressure injury worsened due to insufficient staff care.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
03/28/2025 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20250328130540

FACILITY NAME:ANNA'S HOME & PARADISEFACILITY NUMBER:
197610177
ADMINISTRATOR:ARMENYAN, ANNAFACILITY TYPE:
740
ADDRESS:23463 HAYNES STTELEPHONE:
(323) 660-0001
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 5DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Anna MalkhasyanTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff do not treat residents with dignity or respect
INVESTIGATION FINDINGS:
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At approximately 4:25 p.m. on 04/09/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 04/01/25 and conducted a record review of pertinent records at 8:45 a.m. including but not limited to an admission agreement, medical assessment, and care plan, toured the facility at 9:00 a.m., and interviewed the administrator over the phone at 9:15 a.m. and staff and residents between 9:30 a.m. and 10:00 a.m. LPA conducted a record review of medical records at 2:00 p.m. on 04/08/25 and interviewed Visitor #1 (V1) at 2:15 p.m. on 04/08/25 and Resident #1 (R1) at 3:45 p.m. on 04/08/25. Today, LPA toured the facility inside and out at 4:30 p.m.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250328130540
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ANNA'S HOME & PARADISE
FACILITY NUMBER: 197610177
VISIT DATE: 04/09/2025
NARRATIVE
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Regarding the allegation “Staff do not treat residents with dignity or respect” it was alleged multiple staff yelled at a resident. Interview with R1 revealed they were treated respectfully by staff, but they overheard Staff #1 (S1) and Staff #2 (S2) yelling at Resident #2 (R2). R2 was not available for interview. LPA interviews with three (03) out of four (04) residents revealed staff treat residents with respect and do not yell. Interview with the administrator revealed staff yelled to R1 and R2 because they were hard of hearing. Interview with Staff #1 (S1) at 9:30 a.m. on 04/01/25 and Staff #3 (S3) at 9:40 a.m. on 04/01/25 confirmed that staff increase their volume of speech when talking to residents who are hard of hearing. LPA did not hear any yelling or name calling during visits on 04/01/25 and today. Based on observations and interviews, staff treat residents with respect. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 31-AS-20250328130540
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ANNA'S HOME & PARADISE
FACILITY NUMBER: 197610177
VISIT DATE: 04/09/2025
NARRATIVE
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Interview with the administrator and staff #1 (S1) revealed R1 was hospitalized in February 2025 due to developing a prohibited health condition; a Stage 3 pressure injury. A few days later, R1 was readmitted back to the facility with the same condition with physician orders to reposition R1 every 2 hours. R1 received home health services to care for the pressure injury about three (03) times a week. Caregivers tried to assist R1 in repositioning and caring for their injury, but R1 always refused care. The Administrator and staff revealed that they had knowledge that R1’s pressure injury(s) was/were not healing and continued to be Stage 3. Interview with R1 revealed no staff assisted them with caring for their pressure injury. Interviews with other residents revealed no pertinent information to R1’s wound care. Interview with V1 confirmed R1 was non-compliant with staff care and refused treatment. V1 also noted that R1 was soiled with urine and feces during multiple visits. A review of R1’s preplacement appraisal and medical assessment revealed they were admitted to the facility on 09/24/24 with a Stage 1 pressure injury on their coccyx. Review of R1’s medical records revealed that on 02/05/25, R1 had a new and unstageable wound on their left buttock. A wound consultation from 02/14/25 revealed R1 was diagnosed with a Stage 3 pressure injury on their sacrum. R1 was hospitalized on 03/26/25 with a Stage 4 pressure injury on their sacrum. The facility did not have any home health records available.

Based on record reviews and interviews, staff were aware of R1’s prohibited health condition which got worse due to R1’s noncompliance and lack of care. Furthermore, the facility readmitted R1 back with a Stage 3 pressure injury without doing proper reassessment. Therefore, based on overall investigation, the allegation is deemed SUBSTANTIATED at this time. A deficiency is cited on the LIC 9099-D page. A $500 immediate civil penalty is assessed today for a violation resulting Immediate hazard to health and safety of resident to R1. The licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).

Exit interview conducted. Appeal rights discussed. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20250328130540
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ANNA'S HOME & PARADISE
FACILITY NUMBER: 197610177
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2025
Section Cited
CCR
87615(a)(1)
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87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition... shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by:
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The Licensee has agreed to conduct an in-service training with all staff regarding the cited section and submit proof of correction by tomorrow, 04/10/2025.
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Based on interviews and record review, the licensee did not comply with the section cited above by retaining Resident #1 (R1) with a Stage 3 pressure injury which posed an immediate Health, Safety, or Personal Rights 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: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5