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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610479
Report Date: 06/16/2025
Date Signed: 06/16/2025 03:31:59 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.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
06/10/2025 and conducted by Evaluator Perchui Khurshudyan
COMPLAINT CONTROL NUMBER: 31-AS-20250610173346
FACILITY NAME:GOLDEN YEARS BOARDING CAREFACILITY NUMBER:
197610479
ADMINISTRATOR:KHARATYAN, NINAFACILITY TYPE:
740
ADDRESS:20358 KESWICK STREETTELEPHONE:
(818) 245-2383
CITY:CANOGA PARKSTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 4DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Kharatyan Nina - AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not meeting the residents overall care needs.
Staff are not administering medication as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/16/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an initial 10-day complaint visit to investigate the above allegations. Upon arrival, LPA met with the Administrator Nina Kharatyan and explained the reason for the visit. Entrance interview conducted.

At 10:00am, LPA requested resident and staff rosters. LPA also requested copies of pertinent information which include, but not limited to Admission Agreement, Appraisal Needs and Services, Physician Report, Unusual Incident Reports, copy of Medication Administration Record (MAR), copy of staff training, Hospital discharge paperwork, and additional documents relevant to the investigation. At approximately 10:20am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. No immediate health and safety hazards were noted during the visit. Between 10:30am – 11:40am, LPA conducted interviews with the Administrator, two (2) staff/caregivers, one (witness) POA of the resident (R3) and two (2) out of four (4) residents residing at the facility.
Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
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-20250610173346
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: GOLDEN YEARS BOARDING CARE
FACILITY NUMBER: 197610479
VISIT DATE: 06/16/2025
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
Allegation: Staff are not meeting the residents overall care needs.

It was alleged that R1’s care is neglected, R1 is paraplegic and does not receive appropriate medical care from the board and care in which R1 resides. To investigate this allegation LPA Khurshudyan conducted an interview with the Administrator, two staff members, one witness, and two out of four residents who were able to communicate. Interview with the staff members and the Administrator revealed that all residents receive assistance immediately, they provide care and supervision equally to all the residents in care and never refuse or neglect residents. Staff confirmed that they receive monthly in services / trainings, and they have no reason not to provide appropriate care to residents in care. They also added that R1 received assistance with ADLs, however, R1 had very difficult character from the day arriving to the facility and had very high expectations to receive medical services by the medical professionals and was insisting to receive 1:1 care. Although, R1 was explained that Board and Care facilities are not medical facilities and they do not have medical professionals 24 hours to assist with residents needs, R1 was still unhappy and believed he needed higher level of care. During the period R1 stayed in the facility (four (4) days), R1 constantly repeated that he/she will move to the nursing home since he/she is not happy with the facility services. Interview with one witness and two residents stated that staff is very helpful and is available to help at any time. Additionally, they are very satisfied and have no concerns about the care they receive in the facility. LPA also reviewed staff training on care and supervision, they were recent and complete.
Based on observations, interviews and records review, there is not enough evidence to support the allegation. Therefore, the allegation deemed Unsubstantiated at this time.

Allegation: Staff are not administering medication as prescribed.

It was alleged that R1 is not receiving medicine as needed because R1 is not receiving medical care from a Registered Nurse or Licensed Vocational Nurse. To investigate this allegation LPA Khurshudyan conducted an interview with the Administrator, two staff members, one witness, and two out of four residents who were able to communicate. Interview with the Administrator and two (2) caregivers confirmed that R1 told staff members that he/she will take only those medications that he/she thinks are needed, and he/she will let the staff know when to take them. R1 also added that he/she will take medications for pain and for spasms only. LPA reviewed Medication Administration Record (MAR) which confirmed that R1 refused some of their medications and staff could not convince the resident to take them.

Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250610173346
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: GOLDEN YEARS BOARDING CARE
FACILITY NUMBER: 197610479
VISIT DATE: 06/16/2025
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
Staff also stated that R1 was constantly asking for medical assistance provided by medical professionals, however, R1 was repeatedly informed that Board and Care does not provide 1:1 medical care. LPA interviewed two (2) residents and one (1) witness who denied the allegation and stated that they always get their medication as prescribed by their physician and that the staff gives it to them on time.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

No deficiencies were cited during today's visit.

Exit interview conducted, copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3