195850422-5-8-2025-29-AS-KHEN-DH6U8G-20250530152130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850422
Report Date: 05/08/2025
Date Signed: 05/08/2025 12:23:38 PM

Unsubstantiated

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
10/29/2024 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20241029105719

FACILITY NAME:	ARISE HILLSIDE TREATMENT CENTER		FACILITY NUMBER:	195850422
ADMINISTRATOR:	SHIRINYAN, SYUZANNA		FACILITY TYPE:	772
ADDRESS:	4800 ALMIDOR AVE		TELEPHONE:	(818) 257-1787
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	6	CENSUS: 4	DATE:	05/08/2025
		UNANNOUNCED	TIME BEGAN:	10:53 AM
MET WITH:	Roxana Esquivel - Staff		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not provide adequate supervision to client in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit to deliver findings for the above allegation. LPA arrived at 10:53AM and met with Staff Roxana Esquivel, on behalf of the Licensee, and explained the reason for the visit.

On 10/30/2024 at 3:42PM, LPA Chochian conducted an unannounced initial complaint visit. LPA and Administrator toured the physical plant of the facility at 3:55PM and LIC 500 personnel report was obtained.

On 4/24/2025 at 9:55AM, LPA Huynh conducted an unannounced subsequent visit and conducted interviews with client and staff, reviewed and obtained relevant client files, and toured the physical plant at 10:45AM. In addition, between 04/25/2025 and 05/01/2025, LPA Huynh conducted eight (8) telephone interviews with clients, staff, and witnesses.

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

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 29-AS-20241029105719

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: ARISE HILLSIDE TREATMENT CENTER	FACILITY NUMBER: 195850422
	VISIT DATE: 05/08/2025

NARRATIVE

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During today’s visit, LPA and Staff Roxana conducted a tour of the physical plant areas at 11:04AM to ensure client health and safety and the facility is in compliance with Title 22 regulations. In addition, LPA Huynh conducted interviews with client and staff. Based on interviews, documentation gathered and reviewed, as well as photos and videos provided, the following was determined:

Allegation: “Staff did not provide adequate supervision to client in care.”

On 10/29/2024, it was alleged that Client #1 (C1) was left alone outside the facility while having an emotional breakdown. Interviews with the Licensee, Staff #1 (S1), and C1 revealed that C1 arrived at the facility in their personal car and parked on the facility’s driveway. C1 then informed the Licensee of their arrival via text message where S1 then greeted C1 on the driveway, S1 calmed C1 down, and brought C1 inside the facility where they began the intake process. Ring doorbell footage provided by the Licensee shows S1 greeting C1 at 4:14PM and both entering the facility at 4:15PM. Admission Agreement for C1 was signed at 4:19PM and at that time, C1 became a client of the facility. Interview with one (1) direct Witness (W1) revealed that C1 was leaning against their car “sobbing” but was not causing a disturbance. W1 was concerned about C1’s emotional state. W1 observed C1 on the driveway for ten minutes, during which S1 came outside and spoke with C1, and both entered the facility. W1 provided the Department an eight second video of C1 leaning on the rear of C1’s car crying.

On 04/25/2025, the Department received additional information for an incident that occurred on 04/18/2025. On 04/18/2025, Client #2 (C2) was allegedly wandering the neighborhood streets in distress and abandoned their belongings on the sidewalk. LPA interviewed three (3) Witnesses (Witness #2 - W2, Witness #3 - W3, and Witness #4 - W4) regarding the incident. W2 observed C2 walking past their home at 3:05PM with two suitcases and provided a photo. W3 stated they observed C2 sitting at a nearby bus stop at 4:00PM and was not being disruptive. W4 stated they did not see C2, but at 4:00PM they arrived home and observed an abandoned suitcase on the sidewalk in front of their home. W4 revealed that law enforcement was called at 4:15PM and arrived at 4:55PM where they retrieved the unattended suitcase. Ring doorbell footage and interviews revealed that C2 initially arrived at the facility’s location between 1:00PM and 2:00PM, however C2 gathered their belongings and left the property at 3:03PM. As C2 had not yet been admitted, C2 was not a client at that time. At 5:20PM, C2 returned to the facility, was greeted by S1, and successfully completed the facility’s intake process. C2’s Admission Agreement was signed at 5:30PM and at that time, C2 became a client of the facility.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241029105719

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: ARISE HILLSIDE TREATMENT CENTER	FACILITY NUMBER: 195850422
	VISIT DATE: 05/08/2025

NARRATIVE

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On 05/07/2025, the Department received additional information regarding an alleged incident that occurred at 10:18AM on the same day. It was reported that a client of the facility dropped an item on the private property of a home in the neighborhood. W2 provided video footage of four (4) individuals passing by their home. One (1) out of four (4) individuals, was observed placing an object on W2’s property. W2 revealed it was a green painted rock, and three (3) other neighbors observed their property to have the same object placed on their property. Interview with Staff #2 (S2) and Client #3 (C3) revealed that from 10AM to 10:45AM, S2 conducted a supervised group walk in which three (3) clients participated in the Kindness Rock Project. Therefore, there was no malice intent of placing the rocks throughout the neighborhood and not a result of lack of supervision.

The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may or may not have occurred, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation “staff did not provide adequate supervision to client in care” is deemed UNSUBSTATIATED at this time.

No deficiency cited at this time. Exit interview conducted and copy of today's report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC9099 (FAS) - (06/04)

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