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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850327
Report Date: 07/15/2025
Date Signed: 07/15/2025 07:06:12 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/09/2025 and conducted by Evaluator Christine Yee
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20250709145900
FACILITY NAME:FARMDALE VILLA, INC.FACILITY NUMBER:
195850327
ADMINISTRATOR:PARANDZEM KONSTANYANFACILITY TYPE:
735
ADDRESS:6237 FARMDALE AVENUETELEPHONE:
(818) 620-0955
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 6DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Parandzem Konstanyan, AdministratorTIME COMPLETED:
07:10 PM
ALLEGATION(S):
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1. Staff mishandled the clients medications
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Parandzem Konstanyan, Administrator. The reason for today's vist was provided.

On today's visit, LPA Yee reviewed all 6 clients medications, reviewed facility records and obtained copies of the July 2025 MAR logs and Centrally Stored Medication and Destruction Record.

Per review of the medications and review of the facility records regarding the above allegation that staff mishandled the clients medications, the investigation revealed the following. The Regional Center had scheduled an annual inspection on 6/26/25 at the facility and during the inspection it was observed that Client #1 had a bottle of Pataday, eye drops, 2 generic bottles of eye drops, a prescribed bottle of
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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 4
Control Number 29-AS-20250709145900
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FARMDALE VILLA, INC.
FACILITY NUMBER: 195850327
VISIT DATE: 07/15/2025
NARRATIVE
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Fluticasone, nasal spray and a prescribed tube of Metronidazole topical cream inside the Client's unlocked night stand drawer. Per review of Client #1's Physician Report and follow up letter, the resident is diagnosed with mood disorder, ADHD, Major Depressive Disorder, recurrent, mild, Anxiety and borderline intellectual functioning and is receiving psychiatric treatment. The resident's physician did not indicate that Client #1 is able to retain their own medications. The Licensee did not take steps to ensure that all medications, prescribed or over the counter, were secured from the clients in care. The investigation also revealed that medications are not being dispensed as prescribed. The label on Client #1's PRN Hydroxyzine 10mg medication reads 1/2 - 1 tablet 3 times a day as needed. Per review of the July MAR log, Client #1 has been dispensed 2 tablets of Hydroxyzine in the morning and 1 tablet is dispensed after dinner from 7/1/25-7/15 for anxiety. During the investigation, it was observed that all the Clients have PRN medications, some taken daily, but there is no completed PRN Authorization Letters on file to indicate if the clients are able or unable to determine their own need for a prescription or non-prescription PRN medication. Staff are also not contacting the physician prior to dispensing the medication and are not keeping records of what time the medication was dispensed, dosage taken and the client's response. Staff are making the decisions to dispense the medication for the clients. Resident #4 is also taking Magnesium Citrate gummies and B complex and the bottles are not labeled. It was also observed that the staff dispensing the daily medications are not completing the MAR log directly after dispensing the medication and are inaccurately documenting the medication dispensed. Medications are also stopped without a discontinue order on a script. Based on the information received during the investigation, there is sufficient evidence to support the allegation that staff mishandled the clients medications, therefore the allegation is substantiated at this time.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8.

Exit interview was conducted, APPEALS RIGHTS were discussed and a copy was given.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250709145900
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FARMDALE VILLA, INC.
FACILITY NUMBER: 195850327
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/16/2025
Section Cited
CCR
80075(k)(1)
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Health Related Services: The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of
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The Licensee will ensure that all medications, supplements, prescribed or over the counter are secured and made inaccessible to the clients in care. The eye drops, anti-itch cream and nasal spray were locked up at the time of the annual inspection by the Regional Center. Licensee will provide a written
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the centrally stored medication. This requirement was not met as Pattaday eye drops, prescribed Metronidazole Topical Cream and prescribed Fluticasone Nasal spray were found in Resident #1 unlocked night stand drawer.
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as to how they will ensure that all medications, prescribe or over the counter, are secured at all timeb by 7/16/25
Type A
07/16/2025
Section Cited
CCR
80075(b)(5)(B)
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Health Related Services: (b)Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. If the client's physician has stated in writing that the client is unable to determine his/her own need for nonprescription PRN
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Licensee will provide staff with medication re-training from a medical provider, such as a nurse, Pharmacist and provide evidence that the training has been scheduled by 7/16/25. Licensee will provide evidence that staff have completed the training by 7/22/25.
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medication.....(B) Once ordered by the physician the medication is given according to the physician's directions.
Staff are not following the physician's directions given for Resident #1 PRN Hydroxyzine 10mg
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 Also provide the contact information and address for the trainer.
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: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20250709145900
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FARMDALE VILLA, INC.
FACILITY NUMBER: 195850327
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2025
Section Cited
CCR
80075(b)
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Health Related Services: b)Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. If the client's physician has stated in writing that the client is able to determine and communicate his/her need for a .

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Licensee will ensure that residents who have PRN medications have a completed PRN Authorization Letter from the prescribing phyician on file. Licensee will contact all prescribing physicians to obtain a completed PRN Authorization letter for every prn medication and maintain in each residents
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prescription or nonprescription PRN medication, facility staff shall be permitted to assist the client with self-administration of their PRN medication. All 6 facility clients have PRN medications and no PRN Authorization Letters observed int the residents files.
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file by 7/22/25. FAX a copy of the PRN Authorization Letters to the Department by 7/22/25.
Type B
07/22/2025
Section Cited
CCR
80075(k)(3)
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Health Related Services:The following requirements shall apply to medications which are centrally stored: (3) All medications shall be labeled and maintained in compliance with label instructions and state and federal laws. This requirement was not met as
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Licensee will ensure that all medications and supplements are labeled. The Licensee will ensure that the Magnesium Citrate gummies and B-complex is provided with a label by 7/22/25.
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evidenced by: Clent #4 takes Magnesium Citrate gummines 250 mg and B-complex and neither bottles are labeled,
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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: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4