197610379-2-26-2026-31-AS-TAGD-DSRRE4-20260402125655

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610379
Report Date: 02/26/2026
Date Signed: 02/26/2026 12:28:43 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
02/17/2026 and conducted by Evaluator Angelica Segovia

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20260217155720

FACILITY NAME:	MY HOME FACILITY		FACILITY NUMBER:	197610379
ADMINISTRATOR:	HASMIK NSHANYAN		FACILITY TYPE:	740
ADDRESS:	19837 SEPTO STREET		TELEPHONE:	(830) 505-5505
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	6	CENSUS: 6	DATE:	02/26/2026
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Hasmik Nshanyan-Administrator		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Staff are not treating residents with dignity and respect.
Staff leave residents soiled for extended periods of time.
Residents do not receive adequate recreation time.
Staff are not meeting residents needs.

INVESTIGATION FINDINGS:

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On 2/26/2026 at approximately 9:20 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced initial complaint visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. The Administrator, Hasmik Nshanyan arrived shortly after to assist with today’s visit.

To investigate the allegation(s), at approximately 09:30 AM, LPA conducted a physical plant tour. By 10:00 AM, LPA requested relevant documentation. From 10:00 AM to 12:30 PM, LPA attempted interviews with six (6) residents (R1-R6), two (2) staff members (S1-S2) and conducted record review.

(Contintue to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

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-20260217155720

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: MY HOME FACILITY	FACILITY NUMBER: 197610379
	VISIT DATE: 02/26/2026

NARRATIVE

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Regarding the allegation: Staff are not treating residents with dignity and respect. It was alleged that S2 has yelled at residents and speaks to them in an inappropriate manner. To investigate the allegation, LPA attempted interviews with six (6) residents and two (2) staff members. LPA’s interview with R1 regarding the allegations pertaining to S2 resulted in contradicting statements such as them stating S2, “Barks” at them but then would immediately follow-up by saying S2 was “Nice” to them. LPA’s interview with R2 and R3 revealed that staff do not yell at them or treat them in a disrespectful manner. R3 stated S2, “Speaks loud but is not yelling” at them. LPA attempted to interview R4-R6 but due to their inability to validate the questions being asked, LPA terminated the interviews. LPA’s interview with S1 revealed that S2 has never yelled at residents. LPA attempted to interview S2, but they were not present during LPA’s visit.

During LPA’s physical plant tour, LPA observed staff assisting residents. LPA did not observe any staff yelling at residents. LPA did not observe residents to display any characteristics of being fearful of staff. LPA observed residents interacting with one another including staff.

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

Regarding the allegation: Staff leave residents soiled for extended periods of time. It was alleged that R6 is left in their soiled diaper for an extended period of time. To investigate the allegation, LPA conducted interviews with two (2) residents and one (1) staff member. LPA’s interview with both residents revealed that staff do not leave residents soiled in their diapers for extended periods of time but that residents such as R6 will decline to be changed. LPA’s interview with S1 confirmed, R6 can be difficult at times to change due to their cognitive diagnosis but staff are trained to redirect and attempt again. During LPA’s physical plant tour, LPA observed R6 to be interacting with both staff and residents. LPA did not observe R6 or other residents to omit foul odors such as urine. LPA did not observe R6 to be wet. LPA observed R6 to be well dressed and groomed appropriately.

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

(Continue to LIC 9099-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20260217155720

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: MY HOME FACILITY	FACILITY NUMBER: 197610379
	VISIT DATE: 02/26/2026

NARRATIVE

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Regarding the allegation: Residents do not receive adequate recreation time. It was alleged residents are not being provided with recreational activities. To investigate the allegations, LPA conducted interviews with two (2) residents and one (1) staff member. LPA’s interviews with both residents revealed that they are provided with recreational activities such as going on walks. LPA’s interview with S1 revealed that residents are provided with board games such as bingo in addition to other activities. Upon LPA’s arrival, LPA observed an arts and craft table to display drawings done by the residents. During LPA’s physical plant tour, LPA observed additional activities such as bingo and board games available for residents use. LPA observed sufficient seating in the backyard of the facility with a shaded area. LPA observed residents to be using the outside shaded area.

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

Regarding the allegation: Staff are not meeting residents’ needs. It was alleged that staff are not meeting residents’ needs such as quality of food. To investigate the allegation, LPA conducted interviews with three (3) residents and one (1) staff member. LPA’s interview with R1 revealed that they became ill, including R2, when they consumed food provided to them. R1 could not provide LPA with an exact date of when said event occurred. LPA’s interview with R2 and R3 revealed that their needs are being met. When LPA questioned if they were ever served food within the facility that caused them or others to become sick, both residents denied such allegations. LPA’s interview with S1 confirmed both residents’ interviews.

During LPA’s physical plant tour, LPA observed residents to be served variety of food of good quality. LPA did not observe any of the food to appear molded. LPA observed staff to be cooking and cleaning. LPA observed residents eating the food being served without any residents complaining of feeling sick after consumption.

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

No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

LIC9099 (FAS) - (06/04)

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