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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610471
Report Date: 04/08/2025
Date Signed: 04/08/2025 02:12:10 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
04/02/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250402103719
FACILITY NAME:BOARD AND CARE AYCFACILITY NUMBER:
197610471
ADMINISTRATOR:KNARIK BABAYANFACILITY TYPE:
740
ADDRESS:14950 POLK STREETTELEPHONE:
(562) 600-0606
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 5DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Kanarik Babayan - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff do not provide resident with toiletries

Staff did not provide resident with a copy of admissions agreement
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Administrator Knarik Babayan and explained the reason for the visit.

LPA conducted physical plant tour at 9:34 AM, requested copy of facility documents relevant to the investigation at 9:53 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:30 PM. Regarding the allegation that Staff did not provide resident with a copy of admissions agreement, it was alleged Resident #1 (R1) moved into the facility on 03/17/25 but did not receive a copy of admissions agreement until 4/1/2025. LPA's record review today at 10:00 AM revealed that the admission was signed on 03/15/25 or two (2) days prior to R1's admission by R1's financial responsible person (FRP). LPA's interview with the administrator today at 11:56 AM revealed that when FRP of R1 came and sign the admission agreement, the FRP left in a hurry and was not able to give a copy of the admission agreement but gave a copy of the agreement when they asked. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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-20250402103719
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: BOARD AND CARE AYC
FACILITY NUMBER: 197610471
VISIT DATE: 04/08/2025
NARRATIVE
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(continued from LIC 9099)

Regarding the allegation that Staff do not provide resident with toiletries, LPA's observation today during physical plant tour revealed that the residents' bathroom have toiletries necessary provided by the facility. LPA's interview with three (3) aware staff between 11:00 AM to 1:30 PM revealed that three (3) out of three (3) aware residents stated that they were provided all the toiletries, including but not limited to towel, washcloth, toilet paper, paper towers etc., at all times. LPA attempted to interview two (2) other residents but they are either asleep during visit or on hospice and unable to talk.

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: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3