197610509-10-15-2025-31-AS-NGID-DS5LLK-20260313085114

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610509
Report Date: 10/15/2025
Date Signed: 10/15/2025 03:51:47 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
01/30/2025 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20250130090549

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:	02:00 PM
MET WITH:	Anahit Nersesyan, Staff		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not ensure resident received proper wound care
Staff did not ensure resident was kept clean

INVESTIGATION FINDINGS:

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At approximately 9:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent visit to deliver final findings. 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.

Initial visit was conducted on 02/04/2025 and during course of the investigation, LPA requested resident and staff roster. At 09:45am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, relevant to the investigation. At approximately 10:00am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:20am – 12:30pm, LPA conducted an interview with the Administrator, two (2) staff, a witness/visitor and two (2) out of three (3) residents.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250130090549

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 did not ensure resident received proper wound care

It was alleged that R1 had an open wound below his/her right knee and that ''barrier cream" was put onto the open wound by the facility staff. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that R1 had no pressure wounds. However, due to R1’s medications and dry skin, R1 developed abrasions (on legs) caused by scratching. LPA was informed that the staff redirects R1 and reminds R1 not to scratch his/her legs. LPA was also informed that no cream/ointment was ever prescribed nor applied to R1’s legs. The staff treats R1’s scratches / wound below the knee with soap and water. Interview with two staff members confirmed the statement provided by the Administrator and both staff interviewed denied the above allegation. During the initial visit, LPA observed R1’s legs covered with abrasions caused by itching. LPA also observed proper first aid, like covered scratches with clean dressing placed on R1’s right leg to prevent it from getting infected. Lastly, interview with R1 also confirmed that the staff always provides proper care by cleaning his/her legs with soap and water and no ointment/cream has been ever applied to R1’s leg. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated, at this time.

Allegation: Staff did not ensure resident was kept clean

It was alleged that R1 was covered in old feces upon arrival to the hospital. To investigate this allegation, LPA conducted an interview with the Administrator and two (2) staff members. All parties interviewed denied the above allegation and informed LPA that before R1 was taken to hospital S1 changed R1’s diaper/pull-ups. Interview with R1 also confirmed that prior to paramedic’s arrival on 01/29/25, S1 cleaned and changed R1’s diaper/pull-ups. Additionally, LPA conducted an interview with the facility witness/visitor and was informed that they visit the facility at least twice a week and observed all residents to be clean and well taken care of. Two (2) out of three (3) residents interviewed expressed no concern regarding this allegation. Lastly, during the initial visit, LPA observed the facility common areas and resident rooms were clean and free of odor. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated, at this time.

No deficiency issued.
Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC9099 (FAS) - (06/04)

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