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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610471
Report Date: 07/09/2025
Date Signed: 07/10/2025 09:04:25 AM

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: 6DATE:
07/09/2025
UNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Knarik Babayan - AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff do not assist resident with obtaining medical care

Staff do not assist resident with incontinence care

Staff do not assist resident with bathing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator Knarik Babayan and explained the reason for the visit.

LPA conducted a physical plant tour at 9:12 AM, requested copy of facility documents relevant to the investigation at 9:43 AM. Reviewed records between 10:00 AM to 11:00 AM and interviewed residents between 11:00 AM to 1:00 PM. Regarding the allegation that Staff do not assist resident with obtaining medical care, it was alleged that staff did not arrange for Resident #1 (R1) skilled staff to come to the facility and provide R1 with the blood sugar monitoring training. LPA's record review today between 10:00 AM to 11:00 AM revealed that R1 was admitted with a Home Health agency who was supposed to care for all of R1's medical health needs. LPA's interview with the administrator today revealed that they did not assist R1 on glucose testing as R1 has own device provided by Home Health agency and R1 did not ask for assistance. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
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-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: 07/09/2025
NARRATIVE
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(continued from LIC 9099)

Further review also revealed that R1 was admitted at the facility on 03/07/25 and left on 04/05/25 on R1's own volition.

Regarding the allegation that Staff do not assist resident with incontinence care, it was alleged that staff did not change R1's diapers during the night. LPA's record review of R1's physician's report (LIC 602) today revealed that R1 did not have bowel and bladder impairment. LPA's interview with staff however revealed that R1 was overweight and they had to assist R1 with incontinence care day and night. LPA's interview with three (3) incontinent residents today revealed that three (3) out of three (3) residents stated that they were always asked if they needed to change and change them regularly at least three (3) times (3x) during the day and once or twice (1x to 2x) at night.

Regarding the allegation that Staff do not assist resident with bathing, it was alleged that staff do not assist R1 with bathing. LPA's interview with the Administrator today revealed that R1's home health agency has a bath lady coming for R1 but only came twice during R1's stay here for twenty (20) days. LPA's interview with staff today revealed that the staff offered to give R1 a shower but refused and stated that R1 would rather wait for the home health bath lady. LPA's interview with five (5) residents during this visit revealed that five (5) out of five (5) residents were given showers at least 2x a week as regularly as scheduled.

Based on the information gathered during this and prior 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: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2