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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610392
Report Date: 12/29/2025
Date Signed: 12/29/2025 03:19:05 PM

Substantiated


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
12/19/2025 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20251219113708
FACILITY NAME:JUDD ASSISTED LIVINGFACILITY NUMBER:
197610392
ADMINISTRATOR:AVANESYAN, LIANAFACILITY TYPE:
740
ADDRESS:12615 JUDD STTELEPHONE:
(747) 240-9360
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY:6CENSUS: 3DATE:
12/29/2025
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Ustian (Anne) Ghazanchyan, StaffTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Staff are refusing to accept a resident back into the facility
INVESTIGATION FINDINGS:
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On 12/29/25, Licensing program analyst (LPA) Tihesha Smith made an unannounced 10-day complaint visit to this facility. LPA met with staff and disclosed the reason for the visit.


Staff are refusing to accept a resident back into the facility

It was alleged that staff are refusing to accept Resident #1 (R1) back at the facility. To investigate this allegation, LPA Smith requested copy of facility documents to include but not limited to admissions agreement, personnel report and client roster. LPA Smith interviewed staff between 12:35-2:05 and toured the facility at approximately 1:40 pm. Interview with staff revealed the following: Staff #1 refused R1 back during call with hospital case manager and any S1 revealed refused to take resident back based
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
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-20251219113708
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: JUDD ASSISTED LIVING
FACILITY NUMBER: 197610392
VISIT DATE: 12/29/2025
NARRATIVE
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on conservator’s direction however, per staff admission the resident still resided in the home and had not signed a new admissions agreement with another facility. LPA Smith did not locate any new reappraisals, behavior change notes, or discharge documents from the facility in R1’s records.

Based on interviews there is sufficient information to support the allegation, therefore, the allegation is deemed SUBSTANTIATED at this time

Deficiency cited on 9099D


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

DATE: 12/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20251219113708
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: JUDD ASSISTED LIVING
FACILITY NUMBER: 197610392
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2025
Section Cited
CCR
87468.1
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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:[…](2) to be accorded safe, healthful and comfortable accommodations […] This requirement was not met:
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Administrator/staff will register for the following training
Personal rights enforcement
Eviction law & resident retention
Admission & retention rules

POC:01/15/25
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Based on: staff refused resident admission back to the facility when hopital called to discharge the resident which denies resident safe/ stable accomodations. This poses a potential risk to residents 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: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3