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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610292
Report Date: 06/26/2025
Date Signed: 06/26/2025 02:18:09 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/13/2025 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20250313114301
FACILITY NAME:ARDENT MANORFACILITY NUMBER:
197610292
ADMINISTRATOR:DE GUZMAN, ROILANN CYELLFACILITY TYPE:
740
ADDRESS:22604 PAMPLICO DRIVETELEPHONE:
(213) 804-5665
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:6CENSUS: 4DATE:
06/26/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jesse ValdezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff neglect resulted in a resident sustaining pressure injuries while in care.
Staff neglect resulted in a resident to be hospitalized.
Staff did not meet a resident's incontinence needs while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Jesse Valdez and explained the reason for the visit.

---Staff neglect resulted in a resident sustaining pressure injuries while in care.
---Staff neglect resulted in a resident to be hospitalized.
---Staff did not meet a resident's incontinence needs while in care.

It was alleged that staff did not meet Resident #1's (R1) incontinence needs which resulted in pressure injuries and hospitalization. To investigate the allegations on 03/14/2025 LPA requested documents at around 10:00a.m., interviewed three (03) staff from 11:30a.m. to 1:00p.m. and interviewed two (02) out of three (03) residents from 1:00p.m. to 1:30p.m.

(CONT. on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
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-20250313114301
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ARDENT MANOR
FACILITY NUMBER: 197610292
VISIT DATE: 06/26/2025
NARRATIVE
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 A review of hospital records indicates that R1 was admitted to the hospital on 02/10/2025 with Generalized weakness and Low back, bilateral buttock, and perineal skin breakdown. Hospital records also indicate R1 has a pertinent medical history of advanced urinary incontinence, rashes on back and buttock area. Physicians Report indicates resident is not bedridden, ambulatory and requires incontinent care.

During interviews with staff, all staff stated residents are checked on every one (01) to two (02) hours, are changed minimum six (06) times a day or more if needed and are not left soiled for an extended time. Staff #1 (S1) added R1 is not bedridden, that facility provides adequate incontinent care to all requiring residents and checks on residents frequently.

During interviews with residents, all residents, including R1, stated they feel staff are meeting their needs, meeting their incontinent needs and are not leaving them soiled for an extended time.

Based on interviews and record review, there is not enough information to verify the allegation. Therefore the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2