197610489-9-15-2025-31-AS-NMAN-DLKTVX-20250916150440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610489
Report Date: 09/15/2025
Date Signed: 09/15/2025 10:47:32 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.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
07/02/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250702114521

FACILITY NAME:	VELVET CARE 2		FACILITY NUMBER:	197610489
ADMINISTRATOR:	PAROYAN, NAIRA		FACILITY TYPE:	740
ADDRESS:	16909 CITRONIA STREET		TELEPHONE:	(310) 480-2009
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 5	DATE:	09/15/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Cynthia Sherrie- staff designee		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff chemically restrained resident in care.
Resident was admitted to the facility without consent.
Resident was prevented from moving out of the facility.

INVESTIGATION FINDINGS:

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On 9.15.2025 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced subsequent complaint visit regarding the above allegation. LPA was greeted by Cynthia Sherriel (S2), who is the designated staff member of the facility.

Entrance Interview conducted.

At 10:00 AM with the assistance of S2, LPA conducted a physical plant tour to ensure the health and safety of the residents in care.

Allegation #1: Staff chemically restrained resident in care.

Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

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-20250702114521

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: VELVET CARE 2	FACILITY NUMBER: 197610489
	VISIT DATE: 09/15/2025

NARRATIVE

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The complainant alleged that staff was using medication to sedate resident #1 (R1) as a form of restraint. On 7.9.2025, between 8:40 AM and 9:10 AM, LPA requested and obtained copies of facility documents, including but not limited to the Staff Roster (LIC 500) and the Resident Roster (LIC 9020). In addition, documents from the file of R1 include the Physician’s Report (LIC 602A), Admission Agreement, appraisals, and the Centrally Stored Medication and Destruction Record (LIC 622). Between 9:39 and 10:30am, interviews were conducted with the Administrator and the Responsible Person (W1) for R1 via telephone, and two staff members who assist residents with self-administration of medications. Information obtained did not corroborate the allegation of chemical restraints and indicated medication assistance was conducted based on the doctor’s orders. At 10:30am, LPA conducted interviews with five (5) out of five (5) residents. All residents denied having been chemically restrained or having any knowledge of such a practice occurring at the facility. During the visit, LPA observed the activities of the five residents, which included watching television, taking a walk, and having breakfast. All residents appeared alert and active. The information obtained and the observations of the LPA did not support the allegation, which has been deemed Unsubstantiated at this time.

Allegation #2: Resident was admitted to the facility without consent.

Regarding the allegation, it was reported that R1 was admitted to the facility without family consent. To investigate the allegation, LPA Ngo-Castaneda conducted interviews with the facility administrator and staff #2 (S2), reviewed R1 records, and interviewed residents. The administrator and S1 confirmed that prior to admission, R1 had no family and had been appointed a public guardian. Between 10:30 and 11:30 LPA interviewed five (5) out of five (5) residents. The information obtained indicated the residents consented to their admission and are happy living at the facility. At 1:30pm LPA conducted a telephonic interview with the public guardian assigned to R1. The information obtained confirmed the public guardian had chosen the facility for R1 and authorized R1’s admission. The information obtained, observations, and record review of the LPA did not support the allegation which has been deemed Unsubstantiated at this time.

Continue to LIC 9099-C

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20250702114521

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: VELVET CARE 2	FACILITY NUMBER: 197610489
	VISIT DATE: 09/15/2025

NARRATIVE

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Allegation #3: Resident was prevented from moving out of the facility.

Regarding the allegation, it was reported that R1 was prevented from transferring out of the facility. To investigate the allegation, LPA Ngo-Castaneda conducted interviews with the facility administrator and staff #2 (S2), reviewed R1’s records, and interviewed residents. The administrator and S1 advised that at the time of the admission, R1 had no known family and had been appointed a public guardian. Between 10:30 and 11:30, LPA interviewed five (5) out of five (5) residents. The information obtained indicated that they were happy living at the facility. At 1:30pm LPA conducted a telephonic interview with the public guardian assigned to R1. The public guardian advised that there were currently no plans for R1 to move out or transfer. Based on the information obtained, observations, and record review of the LPA, the allegation which has been deemed Unsubstantiated at this time.

No immediate health and safety hazards were observed during this visit. Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025

LIC9099 (FAS) - (06/04)

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