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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610475
Report Date: 05/21/2025
Date Signed: 05/21/2025 02:11:38 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
01/07/2025 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20250107135728
FACILITY NAME:LOVEBIRD SENIOR LIVING INCFACILITY NUMBER:
197610475
ADMINISTRATOR:SARGSIAN, ARMINEFACILITY TYPE:
740
ADDRESS:13153 CONSTABLE AVENUETELEPHONE:
(818) 284-2502
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 5DATE:
05/21/2025
UNANNOUNCEDTIME BEGAN:
11:59 AM
MET WITH:Armine SargsianTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee retained a resident with a prohibited health condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegation. LPA met with the administrator, Armine Sargsian, and advised her of the complaint. It was reported that Resident 1 (R1) sustained an unstageable decubitus ulcer, resulting in hospitalization. R1 remained at the facility, with this prohibited health condition until hospitalized on 12/21/24, where R1’s wounds were noted.

On 01/08/25, the complaint was referred to Investigations Branch (IB) and accepted as a full investigation, assigned IB investigator Jose Santana. On 01/13/25, LPA Cava conducted the 10 day/initial complaint visit to this allegation to conduct the health and safety inspection and gather records.

IB’s investigation consisted of interviews with facility administrator, facility staff, and witnesses. IB also obtained R1’s medical records for review. The following is the results from IB's investigation:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
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-20250107135728
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: LOVEBIRD SENIOR LIVING INC
FACILITY NUMBER: 197610475
VISIT DATE: 05/21/2025
NARRATIVE
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From 01/15/25 to 02/28/25, IB conducted continuous interviews with facility administrator, staff and witnesses. These interviews reveal that R1 was not being repositioned as instructed on R1’s care plan. Further interviews with witnesses reveal that although staff took care of R1, staff did not consistently reposition R1 as instructed on their care plan. Moreover, it was also revealed that facility staff were not in communication with the home health agency regarding the progress of R1’s wound.

On 01/14/25 and 01/31/25, IB received R1’s medical records and the following were reviewed:
· R1 was admitted to the facility on 11/29/24.
· Home Health was in place to treat R1 for Massive Associated Skin Damage (MASD).
· On 12/05/24, there was some skin discoloration, but was assessed on 12/06/24 to be Stage I.
· On 12/09/24, there was home health orders to provide wound care.
· On 12/14/24, medical records and picture documents stage 3 in sacral area.
· On 12/16/24, despite treatment from home health to address R1’s wounds, R1’s wounds progressed.
· On 12/16/24 to 12/17/24, R1’s wound to the coccyx and heel progressed and was diagnosed by home health to be stage 3 and 4.
· 12/16/24 to 12/20/24, with documentation and the licensee’s knowledge of the wound’s progression to the coccyx and heel, R1 was still retained at the facility for another five days.
· On 12/21/24, R1 was eventually transferred to the hospital for an unrelated medical emergency.

Based on the information obtained, there is sufficient evidence that the licensee retained R1 at the facility with a prohibited health condition. Therefore, the allegation is Substantiated. Citations issued on the 9099D.

Licensee advised of possible Civil Penalty and Enhanced Civil Penalties (ECPs) may be assessed.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250107135728
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: LOVEBIRD SENIOR LIVING INC
FACILITY NUMBER: 197610475
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/21/2025
Section Cited
CCR
87615(a)(1)
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Prohibited Health Conditions- (a)Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1)Stage 3 and 4 pressure injuries. This requirement was not met as evidenced
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As POC, the licensee will hold training to address this section of the regulations. As proof training was held, licensee will submit a copy of the attendance log, training topic with regulations, and date that this training was held by June 4, 2025
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by: Licensee continued to retain R1 after their wound progressed to stage 3 and 4 wound. This posed an immediate health and safety risk to the resident in care.
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Request Denied
Type A
05/21/2025
Section Cited
CCR
87465(a)(1)
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Incidental Medical and Dental Care- The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Licensee failed to transfer R1 to a higher level of care once R1's wounds progressed
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As POC, the licensee will hold training to address this section of the regulations. As proof training was held, licensee will submit a copy of the attendance log, training topic with regulations, and date that this training was held by June 4, 2025
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to stage 3 and 4. This posed an immediate health and safety risk to the resident 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: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3