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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610532
Report Date: 06/03/2025
Date Signed: 06/03/2025 02:07:38 PM

Substantiated


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
05/29/2025 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20250529092935
FACILITY NAME:GOLDEN BLISS BOARD AND CAREFACILITY NUMBER:
197610532
ADMINISTRATOR:MARIANNA GHAZARYANFACILITY TYPE:
740
ADDRESS:8609 AQUEDUCT AVETELEPHONE:
(818) 697-3926
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 3DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Marianna GhazaryanTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff do not maintain documentation of resident(s) records.
INVESTIGATION FINDINGS:
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On 06/03/2025 Licensing Program Analysts (LPAs) Lorena Casillas and Leslie Ngo-Castaneda conducted an unannounced initial complaint visit to investigate the above stated allegations. LPAs were greeted and allowed entry by Administrator Marianna Ghazaryan. LPAs explained the reason for the visit and an entrance interview was conducted.

From 10:00 am to 2:00 pm LPAs toured the facility with Administrator, interviewed three (3) out of three (3) clients, and reviewed facility files. LPA Casillas requested copies of client roster, LIC 500, liability insurance and Administrator Certificate. LPAs also requested copies of pertinent information relevant to the investigation including but not limited to client medical records and any information pertaining to clients in care.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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 5
Control Number 31-AS-20250529092935
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 BLISS BOARD AND CARE
FACILITY NUMBER: 197610532
VISIT DATE: 06/03/2025
NARRATIVE
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Allegation: Facility staff do not maintain documentation of resident(s) records.

It is alleged that facility staff do not maintain documentation of resident records. Regarding this allegation it is reported that Administrator retained and admitted residents into the facility without proper documentation. LPAs interviewed Administrator who admitted to accepting Resident #1 (R1) on 05/26/25, however Administrator stated that they were within the seven (7) days allotted to obtain a signed and finalized Admission Agreement. LPAs inquired on the rest of the documents required for each resident file and Administrator stated that they were not able to complete a file for R1 as R1 was admitted to the hospital the following day on 05/27/25. Administrator admitted to not having a medical assessment for R1 prior to admitting R1 as a resident in the facility. LPAs reviewed resident files and discovered that all documents that are required were in three (3) out of three (3) current resident files. Interviews with Staff #1 (S1) revealed that they are not involved in anything pertaining to documents, they simply care for the residents. Therefore, based on file reviews and interviews, this allegation is deemed substantiated.

Citation issued. Appeal rights discussed and provided. Exit interview conducted and a copy of report given to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20250529092935
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 BLISS BOARD AND CARE
FACILITY NUMBER: 197610532
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2025
Section Cited
CCR
87458(a)
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Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional…and made within the last year, to be kept in the resident's record. This was not met as evidence by:
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Administrator discussed POC with LPA and agreed to voluntary TSP participation as well as writing a statement indicating how compliance will be maintained by POC due date.
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Based on interviews and file reviews the Administrator failed to have a medical assessment for R1 prior to accepting R1 to the facility. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/29/2025 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20250529092935

FACILITY NAME:GOLDEN BLISS BOARD AND CAREFACILITY NUMBER:
197610532
ADMINISTRATOR:MARIANNA GHAZARYANFACILITY TYPE:
740
ADDRESS:8609 AQUEDUCT AVETELEPHONE:
(818) 697-3926
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 3DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Marianna GhazaryanTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility placed resident on hospice without proper consent.
INVESTIGATION FINDINGS:
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On 06/03/2025 Licensing Program Analysts (LPAs) Lorena Casillas and Leslie Ngo-Castaneda conducted an unannounced initial complaint visit to investigate the above stated allegations. LPAs were greeted and allowed entry by Administrator Marianna Ghazaryan. LPAs explained the reason for the visit and an entrance interview was conducted.

From 10:00 am to 2:00 pm LPAs toured the facility with Administrator, interviewed three (3) out of three (3) clients, and reviewed facility files. LPA Casillas requested copies of client roster, LIC 500, liability insurance and Administrator Certificate. LPAs also requested copies of pertinent information relevant to the investigation including but not limited to client medical records, and any information pertaining to clients in care.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250529092935
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 BLISS BOARD AND CARE
FACILITY NUMBER: 197610532
VISIT DATE: 06/03/2025
NARRATIVE
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Allegation: Facility placed resident on hospice without proper consent.

It is alleged that facility placed resident on hospice care without proper consent. Regarding this allegation it is reported that Resident #1 (R1) was placed on hospice, which was later revoked, without meeting the criteria for terminal illness. It is also reported that it is unclear as to who authorized hospice services or if a proper diagnosis was established. Interview with Administrator revealed that they had no knowledge of R1 being on hospice or needing hospice services. Administrator stated that R1 was admitted to the facility on 05/26/25 and was in the facility for less than 24 hours before emergency services were called for R1 and as a result R1 was admitted to the hospital where they are still under care. LPA Casillas contacted alleged hospice agency, Superb Hospice Inc., and they were able to confirm that R1 was on hospice care with from 01/30/2025 to 05/07/25. This places R1 on hospice for dates prior to being admitted to the facility. Therefore, based on interviews this allegation is deemed unsubstantiated.

Exit interview conducted and copy of report was provided to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5