195850426-4-29-2025-29-AS-KLOZ-DH73PM-20250530182547

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850426
Report Date: 04/29/2025
Date Signed: 04/29/2025 03:29:23 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
04/21/2025 and conducted by Evaluator Trevor Byrne

COMPLAINT CONTROL NUMBER: 29-AS-20250421133804

FACILITY NAME:	HARMONY HAVEN SENIOR LIVING INC		FACILITY NUMBER:	195850426
ADMINISTRATOR:	MOVSESIAN, KAJO		FACILITY TYPE:	740
ADDRESS:	8006 RHODES AVE		TELEPHONE:	(818) 804-9406
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 6	DATE:	04/29/2025
		UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Kajo Movesian		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are neglecting resident's care needs.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 09:56 AM. LPA met with facility staff who contacted the facility Administrator Kajo Movsesian. The Administrator arrived to the facility at 10:20 AM the reason for the visit was explained and entrance interview was conducted.

During today’s visit LPA conducted a physical plant tour, reviewed four (4) resident files, reviewed medications for three (3) residents, obtained copies of pertinent documentation, and interviewed the Administrator, one (1) staff and five (5) residents between 10:20 AM and 01:00 PM.

Continued on LIC-9099C

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

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 2

Control Number 29-AS-20250421133804

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: HARMONY HAVEN SENIOR LIVING INC	FACILITY NUMBER: 195850426
	VISIT DATE: 04/29/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The allegation of “Staff are neglecting resident's care needs.” alleges that the facility is not providing adequate care for resident #1 (R1) by neglecting R1’s food needs, administering R1’s medications incorrectly, and not assisting R1 with mobility. LPA Byrne interviewed five (5) current facility residents. Four (4) of the five (5) residents interviewed had no concerns with the quality of care they were receiving at the facility. When interviewed R1 stated that the facility staff are nice and take care of everything for them. R1 stated that facility staff bring their medications at the same time every day and that they are receiving enough food. R1 stated that they do not get out of bed often as they don’t think it is a good idea due to the condition of their legs. R1 confirmed that facility staff check on them regularly and respond quickly to requests for assistance. R1 had no concerns with the quality of care they are receiving at the facility. LPA Byrne conducted a medication audit for R1 and two (2) additional residents. All medications were documented appropriately on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. LPA Byrne interviewed the facility Administrator. The Administrator stated that residents of the facility are fed three (3) meals a day with snacks in-between. The Administrator stated that the facility accommodates resident meal requests if they would like something other than what is being served. The Administrator stated that they encourage residents to be active and to move throughout the facility with staff assistance, but that staff will respect a resident’s decision to stay in bed if they choose. The Administrator stated that they are not aware of any medication issues with the residents and confirmed that medications are given as prescribed and on time each day. LPA interviewed staff #1 (S1) with the assistance of the Administrator acting as a translator. S1 is a caregiver at the facility and confirmed that they assist residents with everything including transferring from bed. S1 stated that there are three (3) residents, including R1, that generally prefer to stay in bed. S1 stated that residents are encouraged to be out of bed for mealtimes and for showers, but staff will always respect a resident’s wish to stay in bed. S1 confirmed that resident medications are given as prescribed and on time each day. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff are neglecting resident's care needs.” Therefore, the allegation is deemed Unsubstantiated at this time.

No deficiencies were cited during today’s inspection. A copy of the report was printed and exit interview was conducted.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2