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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610552
Report Date: 12/23/2025
Date Signed: 12/23/2025 03:26:53 PM

Substantiated


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
12/15/2025 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20251215141106
FACILITY NAME:INGOMAR SENIOR CAREFACILITY NUMBER:
197610552
ADMINISTRATOR:VAHAGN PETROSYANFACILITY TYPE:
740
ADDRESS:19002 INGOMAR STREETTELEPHONE:
(818) 403-1803
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 5DATE:
12/23/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Vahagn Petrosyan, Administrator TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility has a locked gate that was not approved by the fire department/CCLD
INVESTIGATION FINDINGS:
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At 10:00am, Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced visit in response to the above-mentioned allegation. LPA met with the Administrator and explained the reason for the visit.

At 10:10am, LPA requested resident and staff roster. At approximately 10:15am, LPA conducted a physical plant tour. Between 10:20am - 11:00pm, LPA conducted an interview with the Administrator and two (2) staff members.

It was alleged that the “Facility has a locked gate that was not approved by the fire department/CCLD”. On 10/13/25 two (2) credible witnesses conducted a visit to this facility and observed that the gate around the front yard of the facility, where visitors coming in need to be let in. Upon leaving the facility, they noticed a keypad to exit the front gate of the facility, and the door would not open without a code.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
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-20251215141106
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: INGOMAR SENIOR CARE
FACILITY NUMBER: 197610552
VISIT DATE: 12/23/2025
NARRATIVE
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On 11/10/25, Witness 1 (W1) contacted the Administrator (after several attempts) to address the concerns of the locked facility as a restraint and fire hazard for the residents that in case of emergency, they may not be able to exit the facility. Administrator informed W1 that the gate is battery powered and is not affected by electricity. W1 was also informed that licensing had previously raised concern, and the Administrator contacted the fire department to assist them with getting a new lock and security for the facility gate that fits guidelines. Furthermore, on 12/01/25, W1 conducted a subsequent visit to the facility, and the keypad was still present with no ability to leave the facility without being buzzed out by staff or inputting the code. W2 contacted the Los Angeles Fire Department (LAFD) Inspector, Linsay Pelligrini (on 12/12/25), who confirmed that when she approved this location, there was not a keypad lock and that this keypad is a violation of the state Fire Marshall code. Lastly, LPA Panushkina conducted review of facility file and observed that on 10/20/25, the Administrator emailed a request to Community Care Licensing Division (CCLD) for an approval to keep the front door locked. However, LPA Rahimi, replied to the email (on 10/21/25 at 11:10am) by informing the Administrator that a Fire Department must be contacted for such approvals. During today’s visit, LPA Panushkina also observed that the front gate is locked, and the Fire Clearance remains the same (last approved on 03/29/24). Therefore, based on the information obtained from the credible witnesses, facility file review and LPAs observation, this allegation is Substantiated.

Deficiencies issued per CA code of Regulations Title 22 on LIC-9099D.

Exit interview conducted, appeal rights explained and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20251215141106
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: INGOMAR SENIOR CARE
FACILITY NUMBER: 197610552
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/25/2025
Section Cited
CCR
87203
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Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.
This requirement is not met as evidenced by:
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Licensee will remove or replace the lock to insure gate has easy access to enter or exit during emergencies. Proof via photo will be submitted to CCL by POC date.
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Based on LPA observaton, Licensee did not comply with the section cited above by keeping the exterior gate locked. Facility does not have a fire clearance or documentation from the fire department permitting for the use of this type of lock. This poses an immediatel health and safety risk to persons in care.
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This is a zero-tolerance citation and immediate civil penalty of $500 shall be assessed this day. Additional 100 dollars will be assessed until POC is received.
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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: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
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