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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610456
Report Date: 11/25/2025
Date Signed: 11/25/2025 09:38:03 AM

Substantiated


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
05/20/2025 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20250520140015
FACILITY NAME:BREATH OF SUNSHINEFACILITY NUMBER:
197610456
ADMINISTRATOR:SIMONIAN,RUZANNAFACILITY TYPE:
740
ADDRESS:8627 NORWICH AVETELEPHONE:
(323) 683-8080
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 6DATE:
11/25/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:SIMONIAN,RUZANNA- licenseeTIME COMPLETED:
10:14 AM
ALLEGATION(S):
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Facility staff financially abused resident
INVESTIGATION FINDINGS:
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At approximately 8:45 AM, Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit in response to the above-mentioned allegations. LPA met with Staff 1 (S1), who granted access to the facility.

During investigation on 5.27.2025 at 10:30AM, LPA requested the resident and staff roster. Between 11:00 AM – 12:49 PM, LPA conducted an interview with the licensee, three (3) staff, and six (6) out of six (6) residents present at the facility. Between 12:50 PM and 1:15pm, LPA requested and reviewed copies of pertinent information, which included, but were not limited to Physician’s report, Admission Agreement, Power of Attorney (POA), and other documents relevant to the investigation.

Allegation: Facility staff financially abused resident.

Continue to LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
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 5
Control Number 31-AS-20250520140015
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: BREATH OF SUNSHINE
FACILITY NUMBER: 197610456
VISIT DATE: 11/25/2025
NARRATIVE
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It was alleged that the licensee (S1) overcharged resident #1 (R1) responsible party for not picking up their belongings immediately upon death of resident. R1 passed away on 2.27.2025, and R1 belongings were not picked up until 3.10.2025. R1’s responsible party facility charged $1200 extra for 10 days.

Interview with S1 revealed that they did not return the balance of $1200 that was requested by the POA because R1's belongings was not pick-up on time. After being interviewed by LPA, S1 then agreed to return the balance to R1's POA via Zelle. On 5.28.2025, LPA receive a call at 11:57 AM from R1’s POA that $1200 refund was received via Zelle from S1. Interview with residents revealed no issues with monthly dues. A review of R1's records revealed that POA was responsible for paying their rent. A review of R1's most recent invoice confirmed that R1’s POA paid their rent on 2.14.2025 for the month of February, which covers until mid-March 2025. Based on interviews and record review, the facility overcharged R1. Therefore, the allegation is deemed SUBSTANTIATED at this time.

Exit interview conducted. Copy of the report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20250520140015
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: BREATH OF SUNSHINE
FACILITY NUMBER: 197610456
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2025
Section Cited
CCR
87468.2
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Additional Personal Rights... (a) In addition...residents... have all of the following personal rights: (8) To be free from... financial exploitation. This requirement is not met as evidenced by: Based on interviews and record review, R1 was financially exploited by S1
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S1 will refund the balanced owed to R1’s POA.
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which posed an immediate Health, Safety, or Personal Rights 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: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/20/2025 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20250520140015

FACILITY NAME:BREATH OF SUNSHINEFACILITY NUMBER:
197610456
ADMINISTRATOR:SIMONIAN,RUZANNAFACILITY TYPE:
740
ADDRESS:8627 NORWICH AVETELEPHONE:
(323) 683-8080
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 6DATE:
11/25/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:SIMONIAN,RUZANNA- licenseeTIME COMPLETED:
10:14 AM
ALLEGATION(S):
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9
Facility staff did not prevent resident's room from becoming malodorous
INVESTIGATION FINDINGS:
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At approximately (time), Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit in response to the above-mentioned allegations. LPA met with Staff #1 (S1), who granted access to the facility.

During investigation on 5.27.2025 at 10:30AM, LPA requested the resident and staff roster. Between 11:00 AM – 12:49 PM, LPA conducted an interview with the licensee, three (3) staff, and six (6) out of six (6) residents present at the facility. Between 12:50 PM and 1:15pm, LPA requested and reviewed copies of pertinent information, which included, but were not limited to Physician’s report, Admission Agreement, Power of Attorney (POA), and other documents relevant to the investigation.

Allegation: Facility staff did not prevent resident's room from becoming malodorous

Continue to LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250520140015
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: BREATH OF SUNSHINE
FACILITY NUMBER: 197610456
VISIT DATE: 11/25/2025
NARRATIVE
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 It was alleged that R1 bedroom smelled of cigarettes due to S1’s brother smoking close to the R1’s room.

Interviews with facility staff revealed that no one smokes in the facility. No residents complain about any odor in the facility. LPA’s interview with five (5) out of six (6) residents revealed that they did not smell cigarette and they did not experience malodor in the facility. During LPA facility tour on 5.27.2025, there was no odor or cigarette butts observe in the facility, especially in R1 bedroom.

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

Exit interview conducted. Copy of the report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5