197610177-9-5-2025-31-AS-NMAN-DP9TCE-20251211133637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610177
Report Date: 09/05/2025
Date Signed: 09/05/2025 11:40:26 AM

Unsubstantiated

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
06/16/2025 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20250616164325

FACILITY NAME:	ANNA'S HOME & PARADISE		FACILITY NUMBER:	197610177
ADMINISTRATOR:	ARMENYAN, ANNA		FACILITY TYPE:	740
ADDRESS:	23463 HAYNES ST		TELEPHONE:	(323) 660-0001
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	6	CENSUS: 5	DATE:	09/05/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Sona Hakobyan		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff improperly providing medication assistance
Facility staff do not follow modified diets

INVESTIGATION FINDINGS:

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At approximately 8:45 a.m. on 09/05/25 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 06/17/25 and interviewed staff and residents between 9:15 a.m. and 1:30 p.m., toured the facility at 9:30 a.m., and conducted a record review of pertinent records at 10:30 a.m. Today, LPA toured the facility at 9:00 a.m. and conducted a medication review at 9:45 a.m.

Regarding the allegation "Facility staff improperly providing medication assistance" it was alleged staff did not provide proper medication assistance to Resident #1 (R1). Medication review today revealed residents were properly provided assistance with medication. Medications were stored in the correct quantities as well. Interviews with five (05) out of six (06) residents revealed they had no issues with staff’s medication procedures. Interviews with two (02) staff and the administrator revealed all physician orders are followed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250616164325

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: 09/05/2025

NARRATIVE

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Interview with Staff #1 (S1) at 9:15 a.m. on 06/17/25 revealed that after each of R1’s hospitalizations, doctors wrote new orders. They changed one capsule medication to a liquid then changed it back to a capsule days later. Interview with the administrator at 1:20 p.m. on 06/17/25 revealed that despite R1’s frequent hospitalizations and subsequent medication changes, staff always followed all physician orders and updates. Record review of R1’s medication list revealed medication changes on 06/02/25 and 06/10/25. Record review provided no other pertinent information about R1’s medication procedures. Staff training records indicated all staff received training for R1’s special health care needs. Based on interviews and record review, facility staff properly provided medication assistance. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Facility staff do not follow modified diets " it was alleged staff served all residents the same food and did not follow modified diets. Record review of residents’ medical assessments revealed that zero (00) out of six (06) residents had modified diets prescribed by a physician. Review of R1’s medical records revealed R1 “states that [they have] dysphagia, but [they don’t. They] passed swallow evaluation”. Additionally, R1’s records indicated normal Gastrointestinal functioning. Interviews with five (05) out of six (06) residents revealed they enjoyed the food served in the facility. Interviews with two (02) staff and the administrator confirmed no residents have modified diets. Staff and the administrator confirmed that all physician orders are followed. Staff noted all residents are served three (03) meals a day and snacks. LPA observed breakfast service today at 9:00 a.m. and lunch service at approximately 12:00 p.m. on 08/19/25. Meals served to residents contained a nutritious variety of fruits, grains, proteins, and liquids. Food was served in a safe and healthful manner. Based on observations, interviews, and record review, staff serve appropriate meals to residents. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety concerns were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2025

LIC9099 (FAS) - (06/04)

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