195850430-2-25-2025-29-AS-KHEN-DF4TAM-20250325143347

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850430
Report Date: 02/25/2025
Date Signed: 02/25/2025 06:12:50 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
02/22/2025 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20250222205150

FACILITY NAME:	ANGELS HANDS SENIOR LIVING		FACILITY NUMBER:	195850430
ADMINISTRATOR:	GHUKASYAN, MARINE		FACILITY TYPE:	740
ADDRESS:	14819 VALERIO STREET		TELEPHONE:	(818) 679-4442
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	6	CENSUS: 3	DATE:	02/25/2025
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Marine Ghukasyan, Administrator		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Staff are keeping resident at the facility against their will.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and was let into the home by Armine Safaryan, Staff. Staff contacted Marine Ghukasyan, Administrator, via telephone and she arrived at 1:59pm. The reason for today's visit was provided.

LPA Yee conducted an interview with the Administrator at 2:05PM, Witness #1 at 2:36pm, Resident #1 at 3:01pm, Reporting Party at 3:32pm and Witness #2 at 4:22pm. LPA Yee also reviewed Resident #1's file and obtained copies throughout the visit.

Per information received from interviews conducted, Resident #1 was residing at an unlicensed home located on Cedros Avenue and was taken to the hospital for treatment of an infection and hip pain. Prior to Resident #1 being discharged, the Department had already informed Witness #2 that Resident #1 could not be returned to the unlicensed home. Witness #2 had to locate licensed facilities in the vicinity of the

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

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-20250222205150

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: ANGELS HANDS SENIOR LIVING	FACILITY NUMBER: 195850430
	VISIT DATE: 02/25/2025

NARRATIVE

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hospital for new placement for Resident #1. This licensed facility was located and Resident #1 was transported to the home after a discussion was had between Witness #2 and the Administrator. After a couple of days, the Reporting Party contacted the hospital and the facility to advise them that they had stolen the resident from another licensed home. Per information provided by Witness #2, transportation records clearly show that Resident #1 was transported to the hospital from the unlicensed Cedros Avenue location and not from the licensed home that the Reporting Party claimed that Resident #1 was living at prior to hospitalization. Since the placement at this home, Reporting Party has indicated that Resident #1 does not have the mental capacity to decide where they want to live. Reporting Party alleges that Resident #1 is disoriented and confused. Per the Reporting Party, the Licensee informed them that if they want Resident #1, they should come get the resident and pay the licensee. Per interview conducted with Resident #1, the resident was observed to be well oriented, coherent and was having a normal conversation with Witness #1 during their visit in the resident's room. Per Resident #1, they do not want to move from this home. Per Resident #1, if they didn't like it at the home, they would grab their jacket and walk out. They love the food, especially the soup and they get fresh fruits even though Resident #1 eats very little. Witness #1 confirms that Resident #1 loves the home and has not seen the resident so happy in a long time.

Per review of Resident #1's Physician's Report obtained from the hospital on 2/12/25, there is no indication that Resident #1 lacks the mental capacity to make decisions. It is noted that Resident #1 is occasionally forgetful.

Based on today's investigation, there is insufficient evidence to support the allegation that Staff are keeping resident at the facility against their will, therefore the allegation is unsubstantiated at this time.

Exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

LIC9099 (FAS) - (06/04)

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