<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610437
Report Date: 02/27/2025
Date Signed: 02/27/2025 12:54:45 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
02/19/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250219120335
FACILITY NAME:SYLMAR BOARD & CAREFACILITY NUMBER:
197610437
ADMINISTRATOR:OVAKIMYAN, ANIFACILITY TYPE:
740
ADDRESS:13100 FELLOWS AVETELEPHONE:
(818) 665-9631
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 4DATE:
02/27/2025
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Andy Terner - AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff spoke inappropriately to resident.

Facility staff did not safeguard resident's confidential information.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tan conducted an unannounced complaint visit at this facility to investigate the above allegations. LPA met with co Administrator Andy Terner and explained the reason for the visit.

LPA conducted physical plant tour at 9:13 AM, requested copy of facility documents relevant to the investigation at 9:42 AM and interviewed residents and staff between 10:00 AM to 12:30 PM. Regarding the allegation that a Facility staff spoke inappropriately to resident, it was alleged that a staff mocked and made fun of Resident #1 (R1) in front of other residents. LPA’s interview with four (4) residents today between 10:00 AM to 12:30 PM revealed that four (4) out of four (4) residents interviewed did not experience being mocked or made fun of nor witness any staff mocked or made fun of R1. LPA attempted to interview R1 but per interview with the Administrator, R1 moved out of the facility on R1’s own volition on 02/25/25 and did not respond to LPA’s phone call. LPA’s interview with the staff revealed that staff did not make fun or mock R1 at any time nor witness any staff made fun of or mocked R1. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
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-20250219120335
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: SYLMAR BOARD & CARE
FACILITY NUMBER: 197610437
VISIT DATE: 02/27/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(continued from LIC 9099)

Regarding the allegation that Facility staff did not safeguard resident's confidential information, it was alleged that Staff #1 (S1) discussed R1’s medical conditions with other residents. LPA’s interview with four (4) residents today between 10:00 AM to 12:30 PM revealed that four (4) out of four (4) residents interviewed did not hear S1 discussing R1’s medical condition to any of them at any time. LPA attempted to interview R1 but per interview with the Administrator, R1 moved out of the facility on R1’s own volition on 02/25/25 and did not respond to LPA’s phone call. LPA also interview with hospice nurse today at 10:20 AM revealed R1 had a psychiatric condition that made R1 hearing and seeing things that are non-existent, further, the nurse denied hearing S1 discussing anything about R1 at any time. LPA’s interview with S1 revealed that S1 did not discuss R1’s or any resident’s medical condition to anyone.

Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2