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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850523
Report Date: 10/30/2025
Date Signed: 10/30/2025 05:20:48 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
04/22/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20250422092330
FACILITY NAME:PACIFIC SENIOR CAREFACILITY NUMBER:
195850523
ADMINISTRATOR:HAYRAPETYAN, VIKTORYAFACILITY TYPE:
740
ADDRESS:7731 ALDEA AVETELEPHONE:
(818) 516-8819
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY:6CENSUS: 2DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:VIKTORYA HAYRAPETYANTIME COMPLETED:
04:37 PM
ALLEGATION(S):
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Staff neglect resulted in resident sustaining multiple pressure injuries.
Staff did not ensure resident's toileting needs were met.
Staff are unable to communicate with resident due to a language barrier.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint visit to deliver final findings for the allegations cited above. During today’s visit, LPA Urena was greeted by staff, staff contacted the Administrator VIKTORYA HAYRAPETYAN on the phone and the LPA explained the reason for the visit. Administrator was unable to come to the facility and agreed to have the report read over the phone, and asked staff Emilia Hovsepyan to sign the report on their behalf.

On 04/22/2025, the Woodland Hills North Adult & Senior Care Regional Office (WHNASC) Regional Office (RO) received a complaint alleging that the Pacific Senior Care facility staff neglected the care of Resident #1 (R1), resulting in several pressure injuries while in care. On 04/22/2025, the RO referred this case to the Investigations Branch, and Investigator John Canto, was assigned to complete this investigation.
Continues on LIC 9099C 2...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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 7
Control Number 29-AS-20250422092330
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: PACIFIC SENIOR CARE
FACILITY NUMBER: 195850523
VISIT DATE: 10/30/2025
NARRATIVE
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pg. 2
On 04/24/2025, Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegations listed above. The LPA was greeted by staff and contacted the Administrator. The Administrator Viktorya Hayrapetyan arrived at 11:59 a.m., and the LPA informed them of the reason for the visit. LPA Urena interviewed the Administrator and residents and requested documents pertinent to the investigation from approximately 10:30 a.m. to 01:15 p.m. The Administrator was advised that the complaint was referred to the Investigations Branch (IB). The LPA determined further investigation was needed prior to issuing findings.

Staff neglect resulted in resident sustaining multiple pressure injuries.
On 05/06/2025, from approximately 10:00 a.m. to 11:45 a.m., Investigator Canto and Investigator Rojas conducted interviews with R1, Administrator, residents and Staff #1 (S1) and Staff #2 (S2); on 06/27/2025 from approximately 11:00 a.m. to 11:30 a.m. with residents; on 07/02/2025 at approximately 10:45 a.m. with RP; and on 07/02/2025 from approximately 11:15 a.m. to 11:20 a.m. Investigator Canto attempted to interview Staff #3 (S3) and Staff #4 (S4) via telephone. Investigator Canto left voicemails for S3 and S4, and messages were not returned. In addition, Investigator Canto reviewed Kaiser Permanent Medical Records, Doctor’s Choice Home Health Records, Infinite Home Health Records, and facility’s file documents related to the investigation.

According to R1’s Physician Report, dated 02/19/2025, the primary diagnosis was noted as an unspecified dislocated left shoulder secondary to a fall. R1 was noted to require assistance when transferring to and from bed. R1 was admitted to the facility on 02/19/2025.



Continues on LIC 9099C pg. 3...
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 29-AS-20250422092330
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: PACIFIC SENIOR CARE
FACILITY NUMBER: 195850523
VISIT DATE: 10/30/2025
NARRATIVE
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pg.3
The record review revealed that R1 had been at the facility for several months after sustaining a fall at their home. R1 required rehabilitation and was transferred to a rehabilitation center, then subsequently admitted on 02/19/2025 to the Pacific Senior Care facility. R1 said they lived alone and could no longer care for themselves. The facility’s Pre-Placement Appraisal revealed that R1 requires assistance in toileting, including assistance with equipment or assistance from another person when translocating. R1 requires assistance in changing their adult briefs and the assistance of another person in providing peri-care, hygiene, continence, bowel, or bladder control.

In February 2025, Choice Home Health Services noted that several Stage I pressure injuries developed on R1’s heels and buttocks. In April 2025, a review of Infinite Home Health records noted that the pressure injuries were at Stage II, pressure injury present on the interior portion of R1’s left elbow due to the positioning of R1’s body. R1 is also acquiring a Stage II pressure injury on the right buttock and sacral area. Review of the Kaiser medical records noted, “attributed to prolonged bed rest and the use of diapers. R1’s inability to get out of bed has likely contributed to the development of the rash. Severe decubitus ulcer on the buttocks, likely infected, exacerbated by prolonged immobility and diaper use.”

Interviews with staff revealed, the NOC and PM staff did not change female resident’s undergarments such as adult briefs or soiled clothing to avoid residents feeling embarrassed or disrespected and would refer to a female staff. Staff stated during the NOC shift residents are usually asleep. An interview with Resident #2 (2) revealed they sometimes need assistance with repositioning but are rarely repositioned.

Although the facility’s records note the dates and times R1 was bathed and/or repositioned; the information gathered noted that the staff did not provide adequate care for R1, resulting in a severe decubitus rash. Furthermore, the RP witnessed the staff perform improper care for toileting, including decreased unwillingness to change, wet and soiled undergarments, as well as to clean the patient and assist in applying medicated ointment to the pressure injury to prevent further issues; and residents’ interviews revealed that facility staff rarely assist with repositioning residents in care.

Continues on LIC 9099C pg. 4
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 29-AS-20250422092330
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: PACIFIC SENIOR CARE
FACILITY NUMBER: 195850523
VISIT DATE: 10/30/2025
NARRATIVE
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pg.4 The information gathered, noted the pressure injuries were documented under the allowed stage; however, the injuries appeared to be exacerbated to a Stage II because of the lack of repositioning, and lack of adequately changing the adult's briefs as needed. Therefore, the allegation of Staff neglect resulted in resident sustaining multiple pressure injuries is deemed Substantiated at this time.
Staff did not ensure resident's toileting needs were met
On the allegation that Staff did not ensure resident's toileting needs were met. The RP’s concern is that R1 had a soiled undergarment at the time of the visit, and that staff did not change the undergarment until the RP requested the staff to change R1’s soiled undergarment. The interviews conducted by Investigator Canto and Investigator Rojas revealed that the NOC and PM staff did not change female resident’s undergarments such as adult briefs or soiled clothing to avoid residents feeling embarrassed or disrespected and would refer to a female staff. NOC staff stated that they are usually by themselves, and no female staff is present during the night shift. Staff stated during the NOC shift residents are usually asleep.
Based on the information obtained through interviews, the allegation that staff did not ensure resident's toileting needs were met, is deemed Substantiated at this time.
Staff are unable to communicate with resident due to a language barrier;
On the allegation that Staff are unable to communicate with resident due to a language barrier; It is the RP’s concern that staff is unable to communicate with residents due to staff not speaking or understating English. LPA Urena interviewed R1, and the interview revealed that it is difficult to communicate with the staff because they don’t understand or speak English. LPA Urena attempted to interview the staff, and the staff could not readily respond to the questions asked by the LPA. The staff attempted to use a translation application; however, the Administrator attempted to step in and respond for the staff. The LPA concluded the staff’s interview. The residents’ interviews conducted by Investigator Canto and Investigator Rojas revealed that they feel uncomfortable because they feel that staff do not understand English, and there is a communication barrier.
Based on information obtained through interviews, there is sufficient evidence to support the allegation of staff not being able to communicate with residents due to staff’s language barrier. Therefore, the allegation is deemed Substantiated at this time.
Pursuant to Title 22, California Code of Regulations (CCR) and Health and Safety Code, the following deficiency was cited (refer to LIC 9099-D).The Administrator was informed that a civil penalty might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f).”
Citations were issued. Exit interview conducted. A copy of the report and Appeal Rights were issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 29-AS-20250422092330
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: PACIFIC SENIOR CARE
FACILITY NUMBER: 195850523
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2025
Section Cited
CCR
87464(f)(1)
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87464(f)(1) Basic Services.(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c). (c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living …Assistance includes assistance with taking medications, money management, or personal care.This requirement is not met as evidenced by:
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Licensee will …submit a plan to ensure proper incontinent care and repositioning is being provided to the residents.
Submit to CCL by …
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Based on interviews and records review, the licensee did not comply with the section cited above, as R1 was not repositioned and staff performed improper care for toileting, including decreased unwillingness to change, wet and soiled undergarments which resulted in R1 sustaining a stage II wound on the interior portion of R1’s left elbow due to the positioning of R1’s body. R1 also acquiring a Stage II pressure injury on the right buttock and sacral area which posed an immediate health and safety risk to residents in care.
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Type B
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Section Cited
CCR
87468.2
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4)To care…and services that meet their individual needs and are delivered by staff that are sufficient in … qualifications, and competency to meet their needs.This requirement is not met as evidenced by:
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Licensee will submit a plan to ensure residents can readily and promptly communicate their needs to staff
Submit to CCL by …
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Based on interviews, the licensee did not comply with the section cited above, as residents cannot readlily communicate with staff due to language barrier.
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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.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
04/22/2025 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20250422092330

FACILITY NAME:PACIFIC SENIOR CAREFACILITY NUMBER:
195850523
ADMINISTRATOR:HAYRAPETYAN, VIKTORYAFACILITY TYPE:
740
ADDRESS:7731 ALDEA AVETELEPHONE:
(818) 516-8819
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY:6CENSUS: 2DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:VIKTORYA HAYRAPETYANTIME COMPLETED:
04:37 PM
ALLEGATION(S):
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Staff left resident in soiled clothing.
Staff do not provide residents with a sufficient amount of food.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint visit to deliver final findings for the allegations cited above. During today’s visit, LPA Urena was greeted by staff. Staff contacted the Administror VIKTORYA HAYRAPETYAN explained the reason for the visit. Administrator was unable to come to the facility and agrred to have the report read over the phone, and asked staff Emilia Hovsepyan to sign the report on their behalf.


On 04/22/2025, the Woodland Hills North Adult & Senior Care Regional Office (WHNASC) Regional Office (RO) received the complaint, and LPA Urena conducted an intial visit on 04/24/2025.

Continues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 29-AS-20250422092330
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: PACIFIC SENIOR CARE
FACILITY NUMBER: 195850523
VISIT DATE: 10/30/2025
NARRATIVE
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Staff left resident in soiled clothing.
On the allegation that Staff left resident in soiled clothing; it is the RP’s concern that they observed that R1 was wearing a soiled shirt that was not changed by the staff at the time of their visit. On 09/11/2025, LPA Urena interviewed residents about staff assisting with changing their soiled clothing, and the residents stated that staff change their clothing every day. Furthermore, the LPA interviewed staff, and staff stated that they change the resident’s clothing every day, and as necessary.

Although the allegation may have happened or is valid, based on the interviews, and observation, there is not sufficient evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation that Staff left resident in soiled clothing is deemed Unsubstantiated at this time.

Staff do not provide residents with a sufficient amount of food.
On the allegation that staff do not provide residents with sufficient food, it is the RP’s concern that they witness very small portions of food served to residents. The food portions appeared to the RP to be more suited for a small child than to an adult. To investigate the allegation, LPA Urena interviewed residents. Residents stated that they get three meals a day and snacks are offered, and residents can request as well. The residents stated that the portions of food are adequate and if they request more food, the staff will give them more food. Staff’s interviews revealed that they provide three meals a day and offer snacks, fruit, cookies etc. to residents during the day and in between meals. A physical plant observation of the kitchen revealed that there was sufficient food and at least a two-day perishable supply of food.

Although the allegation may have happened or is valid, based on the interviews, and observation, there is not sufficient evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation that Staff do not provide residents with a sufficient amount of food. is deemed Unsubstantiated at this time.

Exit interview was conducted, and a copy of the report was issued.



SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7