195850430-6-11-2025-29-AS-KHEN-DK53LG-20250731182043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850430
Report Date: 06/11/2025
Date Signed: 06/11/2025 08:09:42 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
06/09/2025 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20250609095732

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: 5	DATE:	06/11/2025
		UNANNOUNCED	TIME BEGAN:	10:52 AM
MET WITH:	Marine Ghukasyan, Administrator		TIME COMPLETED:	08:15 PM

ALLEGATION(S):

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1. Staff not allowing resident to leave facility for outings.
2. Facility does not have a phone accessible to residents.
3. Staff unable to meet residents needs due to language barrier.
4. Resident does not have a signed admission agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced initial complaint visit to investigate the above allegations and was let into the home by Armine Safaryan, Staff. Gevorg Gevshenyan, Staff/Spouse of the Administrator, Marine Ghukasyan was contacted and they both arrived at the facility to conduct the visit. The reason for today's visit was provided.

On today's visit, LPA Yee conducted a joint interview with Marine Ghukasyan,Administrator and Gevorg Gevshenyan, Staff/Spouse at 12:27pm, Resident #1 at 11:09am, Witness #1 at 11:57am and Resident #2 - Resident #5 begining at 4:14pm. Resident #1's file was reviewed at 12:20pm and copies were obtained.

Per interviews conducted regarding allegation #1 - Staff not allowing resident to leave facility for outings,the information obtained reveal that Friend #1, who had just found the whereabouts of Resident #1

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025

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 3

Control Number 29-AS-20250609095732

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: 06/11/2025

NARRATIVE

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came to visit. During the visit, Friend #2 also arrived to visit. According to the information provided, Friend #2 greeted Friend #1. Friend #1 responded to the greeting with "in heat like a dog" meanly referring to some incident that had happened years ago and walked outside. Friend #2 followed and wanted to have a conversation with Friend #1 but was not successful. Resident #1, Friend #1 and Friend #2 meet for dances and have known each other for a long while. Per information provided, Friend #1 has a history of drinking in excess, beginning in the morning and doing weed. On the day Friend #1 was visiting at the facility, they were observed to be inebriated and under the influence of something and was overreacting like they do when they have been drinking. Friend #1 went back into the facility to say good-bye to Resident #1 and get the resident's cell phone to take it to get it fixed and left. The phone had been disconnected due to non-payment. Friend #1 would return once the phone was fixed. When Friend #1 returned a few hours later, the phone had not been fixed. Friend #1 asked Gevorg, Staff/Spouse if they could take Resident #1 to get the phone fixed and he responded "no", due to Friend #1's earlier observed condition, reaction and why the phone had not been fixed. Friend #1 then asked Gevorg/Staff if Resident #1 could be taken for a walk and he said okay. Friend #1 and Resident #1 went for a 20-30 minute walk in the neighborhood. Per Gevorg/Staff, he did not want Resident #1 to get into any vehicle driven by Friend #1. After the walk, Friend #1 asked again if they could take Resident #1 to get the phone fixed the following day. Again the response was "no" due to concerns with Friend #1 being inebriated the following day. Per interviews conducted with Resident #1, Witness #1 and Staff, Friend #1 was definitely inebriated and under some kind of influence during the visit. Based on the information obtained, the facility staff does not disallow residents from leaving the facility, they just did not want Resident #1 to be driven around by an inebriated person or anyone under the influence, therefore there is insufficient evidence to support the allegation that Staff is not allowing resident to leave facility for outings and is unsubstantiated at this time.

Per interviews conducted with Resident #1 and other residents regarding allegation #2, Facility does not have a phone accessible to residents, During the interview, Resident #1 immediately responded that the facility has a phone and it is located in the kitchen. Per interviews conducted, the residents have to ask staff for the telephone and it will be given to them. Two residents have a working cell phone and was not sure of the location of the phone since they do not use it. Resident #1 has a cell phone that is not connected due to non-payment and has been using the facility phone to make and receive call. Based on the information

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250609095732

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: 06/11/2025

NARRATIVE

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received, there is insufficient evidence to support the allegation that the facility does not have a phone accessible to the residents, therefore the allegation is deemed to be unsubstantiated at this time.

Per interviews conducted with the residents and LPA's conversation with Staff #1 regarding allegation that staff is unable to meet residents needs due to language barrier, reveal that Staff #1 speaks sufficient English to communicate with the residents and provide the basic services. Staff #1 however has a little more difficulty when it comes to more complicated words and uses a Google translator to assist in the communication. Per interviews with the Administrator and Gevorg, they are present at the facility all the time and are available if there are any emergencies or staff can call them on the phone. Residents all indicate that they are able to communicate with the staff sufficiently in English to get want they want. Based on the information received, there is insufficient evidence to support the allegation that staff is unable to meet the residents needs due to language barrier, therefore the allegation is unsubstantiated at this time.

Regarding allegation #4 - Resident does not have a signed Admission Agreement, LPA Yee reviewed Resident #1's file and a copy of the Admission Agreement signed on 2/12/25 was observed in their file. Per information obtained during the visit, Resident says things and does things and does not remember. Per review of Resident #1's Physician's Report, the resident may have mild cognitive impairment or onset of dementia. Both boxes were checked off on the Physician's Report and the diagnosis is unclear. The facility was asked to contact the resident's physician to seek clarification and maintain in the resident's file. Based on the information obtained, there is insufficient evidence to support the allegation that Resident does not have a signed Admission Agreement, therefore the allegation is unsubstantiated at this time.

Exit interview was conducted and a copy was provided

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025

LIC9099 (FAS) - (06/04)

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