197610506-12-30-2025-31-AS-NMAN-DQHSRJ-20260120130624

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610506
Report Date: 12/30/2025
Date Signed: 12/30/2025 09:51:25 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.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
04/04/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250404163531

FACILITY NAME:	BEST CARE ASSISTED LIVING ON HASKELL		FACILITY NUMBER:	197610506
ADMINISTRATOR:	GEVORKYAN, SIRANUYSH		FACILITY TYPE:	740
ADDRESS:	9756 HASKELL AVE		TELEPHONE:	(310) 720-4551
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 5	DATE:	12/30/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ani Andrade- Designee		TIME COMPLETED:	10:10 AM

ALLEGATION(S):

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Staff over medicated a resident contributed to residents death.
Staff did not keep facility free of an illegal substance.
Staff placed a resident on hospice without authorization.

INVESTIGATION FINDINGS:

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On 12.30.2025 at 9:00 AM, Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at this facility to conduct an unannounced subsequent complaint visit to deliver the final determination of the above-noted allegations. LPA was granted entry into the facility by the staff #1 (S1) and explained the reason for the visit. An entrance interview was conducted.

At the time of this visit, at approximately 9:10 AM, LPA conducted a physical plant tour of the facility. LPA did not observe any immediate health and safety issues.

To investigate the allegations, prior to the initial visit on 4.7.2025, LPA Ngo-Castaneda subpoenaed medical records from the hospital.

Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

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-20250404163531

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: BEST CARE ASSISTED LIVING ON HASKELL	FACILITY NUMBER: 197610506
	VISIT DATE: 12/30/2025

NARRATIVE

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On 04/08/25, LPA Ngo-Castaneda conducted an initial complaint visit at which time, at approximately 10:19 AM, LPA conducted a physical plant tour of the facility. From 12:30 PM – 1:30 PM, LPA interviewed three (3) staff members present in the facility and five (5) residents. At 11:00 AM, LPA requested copies of pertinent information which included, but not limited to Physician’s report, Admission Agreement, Staff Training, LIC 500, resident roster, needs and service plan, and other relevant documents to the investigation. Before this visit on 4.7.2025, LPA reviewed the documents previously gathered from the facility.

Allegation #1: Staff over medicated a resident contributed to resident’s death.

It was alleged that facility staff over-medicated resident #1 (R1), resulting/contributing in their death. LPA interviewed five (5) residents on 4.8.2025, and it was revealed that residents do not have any issues with staff over medicating anyone at the facility. During interviews with staff, it was revealed that all medications are given as prescribed. LPA reviewed R1’s medical records, which revealed that on 3.21.2025, no drug overdose was found in R1's system. R1’s death was due to ‘cardiac arrest’ on 4.1.2025.

Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Allegation #2: Staff did not keep the facility free of an illegal substance.

It was alleged that the facility kept an illegal substance that R1 took and consumed. During LPA Ngo-Castaneda facility plant tour, medication review, and observation, LPA did not observe any ‘illegal substance’ in the facility. During interviews with staff, it was revealed that all medications are given as prescribed. All of the staff confirmed that no one uses or sells drugs in the facility. During interviews with residents, all interviewed residents stated that they were given their medications as prescribed. Residents revealed no occurrences of illegal drug use or sales in the facility.

Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Continue to LIC 9099-C

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20250404163531

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: BEST CARE ASSISTED LIVING ON HASKELL	FACILITY NUMBER: 197610506
	VISIT DATE: 12/30/2025

NARRATIVE

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Allegation #3: Staff placed a resident on hospice without authorization.

It was alleged that R1 was placed on hospice care without their consent. LPA phone interview with R1 family at 12:15 PM on 4.8.2025 revealed that R1’s family was aware of what they signed and was advised on the services that hospice will provide. LPA interview with staff revealed that R1 was admitted at the facility on 1.17.2025. Before being admitted to the facility, R1's family signed and agreed to R1 to receive hospice care. R1’s hospice care was approved by Circle of Life Hospice coverage on 1.01.2025.

Based on the information provided and record review, the allegation is deemed to be UNSUBSTANTIATED at this time.

No immediate health or safety hazards were observed during today’s visit.
Exit interview conducted. Copy of this report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

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