197610532-9-15-2025-31-AS-NMAN-DLKUKD-20250916153858

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610532
Report Date: 09/15/2025
Date Signed: 09/15/2025 11:55:07 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
06/17/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250617185613

FACILITY NAME:	GOLDEN BLISS BOARD AND CARE		FACILITY NUMBER:	197610532
ADMINISTRATOR:	MARIANNA GHAZARYAN		FACILITY TYPE:	740
ADDRESS:	8609 AQUEDUCT AVE		TELEPHONE:	(818) 697-3926
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 3	DATE:	09/15/2025
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	MARIANNA GHAZARYAN- Licensee		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Staff retaining resident against her will.
Staff do not provide resident medications as prescribed.
Staff ignored resident's request for medical treatment.

INVESTIGATION FINDINGS:

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On 9.15.2025 at 11:10 AM, Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at this facility to conduct an unannounced subsequent complaint visit to deliver final determination of the above noted allegations. LPA was granted entry into the facility by the staff #1 (S1). An entrance interview was conducted.

At the time of this visit, at approximately 11:15 AM, LPA conducted a physical plant tour of the facility. LPA did not observe any immediate health and safety issues.

To investigate the allegations, LPA Ngo-Castaneda conducted an initial complaint visit on 06.19.2025 at which time, at approximately 11:16 AM, LPA conducted a physical plant tour of the facility. While conducting the physical plant tour, LPA interviewed a resident 1 (R1), who was sitting at the patio, and three (3) other residents who were present in the facility. Per LPAs observation R1 was using a walker and able to respond to the questions.
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)

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Control Number 31-AS-20250617185613

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: 09/15/2025

NARRATIVE

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At 11:30 AM, LPA interviewed licensee; staff #1 (S1), staff # 2 (S2). At 12:30 PM, LPA Ngo-Castaneda requested and obtained copies of relevant documents, including, but not limited to, the following: client roster, personnel report, R1's physician’s report, admissions agreement, appraisal needs and service plan, incident reports and other documents. Prior to this visit on 6.19.2025 at 1:00 PM LPA reviewed the documents previously gathered from the facility.

Allegation #1: Staff retaining resident against her will

It was alleged that staff restrained a resident #1 (R1) by not letting them leave the facility. R1 wanted to be relocated to another facility. Staff revealed that R1 is looking for another facility and has all the freedom to be relocated. Staff denied not allowing R1 from leaving facility. They stated that per doctor’s report R1 cannot leave the facility unassisted. Therefore, they made sure that R1 is leaving with staff assistance. Residents interviewed during investigation revealed that they are not restrained from leaving the facility. A review of R1’s facility record revealed that R1 is requiring assistance to leave the facility. Based on observation, interviews and record review, there is insufficient evidence to support the allegation that staff inappropriately restrained residents. Therefore, the allegation is deemed Unsubstantiated at this time.

Allegation #2: Staff do not provide resident medications as prescribed.

It was alleged that staff failed to administer prescribed medications to residents. Staff revealed that they are providing medication assistance and R1 refuses to take the medication. Staff also stated they sent documentation to R1’s PCP for not taking their medication and PCP consented. Incident report(s) for medication refusal was sent to Woodland Hiss Licensing Office. Interview with R1 at the patio confirmed that R1 is getting medication assistance. However, they refuse to take their medication. Other residents had no concerns regarding their medication assistance. A review of R1’s medication records and other documents verified the information revealed from interviews.

Based on observation, interviews, and record review there is no sufficient information to verify the allegation. Therefore, the allegation is 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-20250617185613

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: 09/15/2025

NARRATIVE

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Allegation #3: Staff ignored resident's request for medical treatment

It was alleged that R1 was ignored when requesting to be sent to the hospital for pain. Staff revealed that on 06/11/25 R1 did not fall well and requested to be sent to the hospital. 911 was called and R1 was transported to the hospital by paramedics. Although R1 verified that they were sent to hospital, they assumed they were ignored. Other residents did not address any concerns regarding their medical treatments. A review of incident report submitted by the facility verified the information revealed from interviews. Based on interviews and documentation review, there is insufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted, a copy of this report was signed and delivered.

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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