197610509-12-10-2025-31-AS-AJWR-DPFVUT-20251217154515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610509
Report Date: 10/15/2025
Date Signed: 12/10/2025 12:49:09 PM

Unsubstantiated

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
10/09/2025 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20251009121033

FACILITY NAME:	KK SUNNYBRAE SENIOR LIVING		FACILITY NUMBER:	197610509
ADMINISTRATOR:	PODRUMYAN, MARO		FACILITY TYPE:	740
ADDRESS:	10012 SUNNYBRAE AVE		TELEPHONE:	(818) 632-2742
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	6	CENSUS: 5	DATE:	10/15/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Anahit Nersesyan, Staff		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff is financially abusing a resident
Staff is interfering with a resident's insurance
Staff threatened a resident with eviction

INVESTIGATION FINDINGS:

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This is an amended to the original report issued 10/15/2025. Additional information was added to clarify the investigation.

At approximately 09:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit in response to the above-mentioned allegations. LPA met with the Staff #1, who granted access to the facility. LPA contacted the Administrator and explained the reason for the visit. LPA was informed that the Administrator will not be able to come and designated S1 to sign the report.

At 09:15am, LPA requested resident and staff roster. At 09:20am, LPA requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, Staff Trainilng, relevant to the investigation. Between 09:30am – 11:30am, LPA conducted an interview with the Administrator, two (2) staff, R1's Power of Attorney (POA) and four (4) out of five (5) residents. Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025

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-20251009121033

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: KK SUNNYBRAE SENIOR LIVING	FACILITY NUMBER: 197610509
	VISIT DATE: 10/15/2025

NARRATIVE

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Allegation: Staff is financially abusing a resident

It was alleged that the Administrator is attempting to redirect R1’s Social Security Income (SSI) into another account and will often call the Social Security Administration (SSA) regarding R1’s payments without R1’s knowledge. To investigate this allegation, LPA conducted an interview with the Administrator who denied the allegation and informed LPA that she can't solely make any changes as she does not have the authority to do so. Administrator also informed LPA that R1 wanted to schedule an appointment with SSA and asked the Administrator to schedule it for him/her. Around end of 09/29/2025 or 09/30/2025, the Administrator contacted the SSA's (1800…) number and scheduled an in-person appointment for 10/06/2025. R1 was taken to SSA by the Administrator on his/her scheduled day and no other phone calls to SSA were made by the Administrator on R1’s behalf. Interview with R1 also confirmed that R1 asked the Administrator to schedule an appointment and no other calls were made to SSA by the Administrator. LPA contacted R1's Power of Attorney (POA) and was informed that he/she is well aware of the call, made by the Administrator, to schedule an appointment for R1. Four (4) out of five (5) residents interviewed expressed no concern regarding this allegation. Therefore, based on interviews and information gathered during today’s visit this allegation is deemed Unsubstantiated, at this time.

Allegation: Staff is interfering with a resident's insurance

It was alleged that the Administrator changed R1’s insurance without involving R1. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that when R1 was picked up from the nursing home, the Administrator had a conversation with R1 and R1’s POA about Medi-Cal plan that may cover long-term services and supports (LTSS). All parties agreed to make changes, so that R1’s Medi-Cal plan can help coordinate access to state programs that cover supportive services, such as Assisted Living Waiver (ALW). LPA contacted R1’s responsible person and also conducted an interview with R1. Both parties interviewed corroborated the statement provided by the Administrator. Four (4) out of five (5) residents interviewed expressed no concerns regarding the above allegation and informed LPA that the facility Administrator and the staff are very respectful and professional toward their personal rights and before any changes are made, the Administrator always communicates with residents and or their responsible party. Therefore, based on interviews and information gathered during today's visit this allegation is deemed Unsubstantiated, at this time.
Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20251009121033

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: KK SUNNYBRAE SENIOR LIVING	FACILITY NUMBER: 197610509
	VISIT DATE: 10/15/2025

NARRATIVE

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Allegation: Staff threatened a resident with eviction

It was alleged that the Administrator threatens to evict R1 if R1 does not cooperate. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that facility has not issued or verbally mentioned any eviction to R1. Additionally, the Administrator stated there are currently no pending eviction notices that were issued, and she hasn't had to issue an eviction to anyone within the last 30-60 days. Interview with R1 and R1 POA expressed no concerns regarding this allegation. Lastly, R1’s records were reviewed, and LPA did not observe an eviction that has been issued to R1. Therefore, based on interviews and record review this allegation is deemed Unsubstantiated, at this time.

No deficiency cited during today's visit.

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

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025

LIC9099 (FAS) - (06/04)

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