197610362-12-23-2025-31-AS-NMAN-DPUTPV-20251230135457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610362
Report Date: 12/23/2025
Date Signed: 12/23/2025 04:37:32 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.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
12/16/2025 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20251216090008

FACILITY NAME:	ANTORIA ASSISTED LIVING OF TARZANA		FACILITY NUMBER:	197610362
ADMINISTRATOR:	CAMPOS, MARYCEL		FACILITY TYPE:	740
ADDRESS:	5912 CAHILL AVENUE		TELEPHONE:	(626) 840-2830
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	6	CENSUS: 4	DATE:	12/23/2025
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Arlene Aragon		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff are not meeting the needs of a resident
Staff do not respond timely to a resident's alert
Staff are mishandling a resident's medications
Staff are not meeting a resident's bathing needs
Staff do not provide adequate food service

INVESTIGATION FINDINGS:

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At approximately 8:40 a.m. on 12/23/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. LPA called the administrator at 9:40 a.m. and disclosed the reason for the visit.

To investigate the allegations above, LPA interviewed staff and residents between 8:45 a.m. and 11:00 a.m. today, toured the facility inside and out at 9:00 a.m., and conducted a record review of pertinent records, including but not limited to an admission agreement, medical assessment, face sheet, and staff and client rosters at 9:30 a.m.

Regarding the allegation "Staff are not meeting the needs of a resident" it was alleged staff did not provide care and necessary services to Resident #1 (R1). Review of R1’s admission agreement revealed the facility agreed to provide all basic services under Title 22 regulations such as care and supervision, 24 hour observation, and assistance with meals, medications, laundry, bathing, and other activities of daily

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025

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 31-AS-20251216090008

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: ANTORIA ASSISTED LIVING OF TARZANA	FACILITY NUMBER: 197610362
	VISIT DATE: 12/23/2025

NARRATIVE

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living. Interviews with the administrator at 9:40 a.m. today and Staff #1 (S1) at 9:50 a.m. today revealed they provided all agreed upon services to R1 and all other residents. Interviews with three (03) out of four (04) residents revealed all of their care needs were met. Interview with Resident #2 (R2) at 9:10 a.m. today revealed they need more support in transferring from their bed, but all of their other needs were met. During today’s visit, LPA observed S1 preparing food for residents, providing incontinence assistance, and responding to call system requests between 8:45 a.m. and 11:00 a.m. Based on observations, interviews, and record review, staff are meeting the needs of residents. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff do not respond timely to a resident's alert" it was alleged staff have a delayed response to resident requests. Interviews with four (04) out of four (04) residents today revealed staff come quickly when they request assistance. Interview with S1 revealed the facility call system is very loud. S1 assists residents promptly when they call for assistance. LPA and S1 tested the facility call system today between 9:15 a.m. and 10:45 a.m. The buzzers were operational and audible in all five (05) resident rooms. Interview with Resident #3 (R3) at 10:45 a.m. today revealed that each resident has a unique call system sound. R3 recalled staff assisting R1 promptly after they requested assistance. Based on observations and interviews, staff respond in a timely manner to resident alerts. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff are mishandling a resident's medications" it was alleged R1 may not have received assistance with all medications. LPA reviewed R1’s medications with S1 at approximately 9:50 a.m. today. Interview with S1 revealed they followed all physician orders as well as discontinue orders of medications. The facility did not maintain a medication administration record. Interviews with four (04) out of four (04) residents revealed they received all medications in the proper dosages at the correct times. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff are not meeting a resident's bathing needs" it was alleged R1 did not receive a shower for weeks. It was also noted that they received bed baths consistently. Review of R1’s admission agreement revealed the facility agreed to provide assistance and reminders for their bathing needs. Interview with S1 revealed they provided daily bed baths to R1, R2, and R3. S1 and hospice nurses also provided shower assistance to Resident #4 (R4) and Resident #5 (R5).

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20251216090008

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: ANTORIA ASSISTED LIVING OF TARZANA	FACILITY NUMBER: 197610362
	VISIT DATE: 12/23/2025

NARRATIVE

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Interviews with four (04) out of four (04) residents revealed they receive sufficient assistance with their bathing needs. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff do not provide adequate food service" it was alleged the facility provides only Filipino food. Interviews with three (03) out of four (04) residents revealed they enjoyed the food provided. Interview with R2 revealed they would prefer more fresh foods, not froze foods. Interview with R5 at 8:55 a.m. today revealed their favorite meal made by the facility was pancakes and cereal. No residents believed that the facility only provided Filipino food. Interview with S1 revealed they ask residents about their preferences and try to accommodate them. S1 showed LPA tonight’s planned dinner consisting of meatballs and stroganoff. At approximately 9:00 a.m. LPA observed today’s breakfast which consisted of cereal, hashbrowns, fresh fruit, and eggs. LPA observed the weekly menu posted in the kitchen as well as a sufficient supply of perishable and non-perishable foods. Based on observations and interviews, the facility does not provide only Filipino food. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety concerns 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: 12/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025

LIC9099 (FAS) - (06/04)

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