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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850423
Report Date: 08/19/2026
Date Signed: 08/19/2026 05:49:03 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
05/21/2026 and conducted by Evaluator Quoc Huynh
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20260521102549
FACILITY NAME:IVY PARK AT WOODLAND HILLSFACILITY NUMBER:
195850423
ADMINISTRATOR:LILIT MNATSAKANYANFACILITY TYPE:
740
ADDRESS:20461 VENTURA BLVD.TELEPHONE:
(818) 346-9046
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:127CENSUS: 89DATE:
08/19/2026
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Lilit Mnatsakanyan - Executive DirectorTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff mismanage residents medications
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Quoc Huynh and Angela Barutyan conducted a subsequent complaint to deliver findings for the above allegation. The LPAs arrived at 9:40AM and met with Executive Director (ED) Lilit Mnatsakanyan. Entrance interview conducted.

On 05/27/2026, LPA Huynh conducted an initial complaint visit. Between 2:43PM and 5:42PM, the LPA conducted a physical plant tour and interviewed one (1) staff and reviewed and obtained pertinent documents.

During today’s visit, the LPAs conducted a physical plant tour at 10:08AM, and no immediate concerns were observed. The following was then determined:

Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026
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 29-AS-20260521102549
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: IVY PARK AT WOODLAND HILLS
FACILITY NUMBER: 195850423
VISIT DATE: 08/19/2026
NARRATIVE
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Allegation: “Staff mismanage residents medications”

It was reported that facility staff did not refill four (4) of Resident #1’s (R1) medications, resulting in R1 not receiving these medications for over thirty (30) days. Interview with Staff #1 (S1) confirmed the oversight and revealed that there had also been a miscommunication regarding R1’s primary care physician (PCP). R1’s PCP had changed, and the facility was not notified. After S1’s attempt to resolve the issue, it was discovered that R1’s pharmacy had not been informed of the PCP change, preventing renewal of R1’s medication orders. S1 additionally reported that the facility’s Medication Technicians noted the medication discrepancies on the Medication Administration Record (MAR) but did not conduct any further follow up. The Medication Technicians listed the medications as “not on hand” in the MAR.

Record review showed that R1’s medications were documented as “not on hand” from varying start dates to 05/20/2026 when medications were filled and resumed: Citracal+D 600MG starting 03/24/2026, Donepezil 10MG starting 04/17/2026, Memantine 10MG starting 04/11/2026, Mirtazapine 15MG starting 05/01/2026, and Losartan 25MG starting 05/05/2026. On 04/29/2026, the facility requested R1’s PCP to provide a new order for Citracal+D, and on 05/05/2026, requested new orders for the remainder of R1’s medications. The PCP provided the new orders on 05/06/2026. The facility’s MAR documented that R1 resumed receiving the missing medications on 05/20/2026, resulting in discrepancies of up to fifty-seven (57) days.

Additionally on 07/06/2026, the Department received an Incident Report stating that on 06/30/2026 Resident #2 (R2) was scheduled to receive a dose of ten (10) units of Tresiba and it was not administered.

Based on interview and record review, the preponderance of evidence standard has been met; therefore, the allegation is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiency was cited (Refer to LIC 9099-D).

Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260521102549
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: IVY PARK AT WOODLAND HILLS
FACILITY NUMBER: 195850423
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/20/2026
Section Cited
CCR
87465(a)
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(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:

This requirement was not met as evidenced by:
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The Licensee will submit a statement of understanding of the section cited and provide proof to CCLD by POC due date.
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Based on interview and record review, the Licensee did not comply with section cited above as R1’s medications were not refilled and subsequently not administered for over 30 days, and R2 was not administered their prescribed medication which posed an immediate health, safety, and personal rights risk to person 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.
SUPERVISOR'S NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026
LIC9099 (FAS) - (06/04)
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