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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850612
Report Date: 05/28/2026
Date Signed: 05/28/2026 03:25:23 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
12/05/2025 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20251205112600
FACILITY NAME:LAUREL CANYON RESIDENTIAL CAREFACILITY NUMBER:
195850612
ADMINISTRATOR:HARUTYUNYAN, KRISTINEFACILITY TYPE:
740
ADDRESS:8054 LAUREL CANYON BLVDTELEPHONE:
(747) 474-9514
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 4DATE:
05/28/2026
UNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Kristine HarutyunyanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not notice residents change in condition
Neglect/lack of supervision
Staff did not notify residents authorized representative of hospitalization
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 01:13 PM. LPA met with facility staff who contacted the Administrator Kristine Harutyunyan. The Administrator arrived at 01:20 PM. Entrance interview was conducted and the reason for the visit was explained.

On 12/05/2025 the Woodland Hills North Adult and Senior Care Regional Office (RO) received a complaint alleging that facility staff did not notice Resident #1’s (R1) change in condition, staff did not notify R1’s authorized representative of hospitalization, and Neglect/lack of supervision of R1. The complaint was investigated by the Department.

CONTINUED ON LIC 9099C.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
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 6
Control Number 29-AS-20251205112600
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: LAUREL CANYON RESIDENTIAL CARE
FACILITY NUMBER: 195850612
VISIT DATE: 05/28/2026
NARRATIVE
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On 12/08/2025 LPA Sandra Urena initiated the investigation and conducted a physical plant tour, interviewed the Administrator, and collected copies of pertinent documentation. During the course of the investigation, the Department subpoenaed medical records, the EMS report, 911 call audio, call logs and other pertinent records for Staff #1 (S1). On 02/03/2026 an Investigator conducted a physical plant tour at the facility and conducted interviews with Resident #2 (R2). Additionally, interviews were conducted on 02/05/2026 with Witness #1 (W1), on 03/13/2026 with Witness #3 (W3), on 04/23/2026 with the Administrator, and on 05/01/2026 with Witness #4 (W4). Multiple attempts between 02/03/2026 and 04/01/2026 were made to interview R1, although R1 could not be located. During today’s visit LPA conducted a physical plant tour, collected copies of pertinent documentation, and conducted interviews with the Administrator and Assistant Administrator between 01:20 PM and 03:00 PM.

The allegations of “Staff did not notice residents change in condition” and “Neglect/lack of supervision” allege that facility staff did not notice a change in condition of R1 which resulted in R1 being admitted to the hospital in critical condition and that facility staff failed to take appropriate timely actions to address a change in condition of R1.

Interview with the Administrator revealed on 12/01/2025 they contacted 911 because R1 did not look/feel good. The Administrator stated that they first observed R1 feeling unwell on either Thursday, 11/27/2025, or Friday, 11/28/2025. The Administrator stated that they did not call 911 before because “R1 was not that bad,” but the Administrator got scared when they noticed R1’s low blood pressure. The Administrator stated that on 11/27/2025 or 11/28/2025 they noticed that R1 was “coughing with phlegm,” without any breathing problems. The Administrator stated that they gave R1 one (1) Medication #1 (M1) tablet for the phlegm on 11/27/2025 or 11/28/2025. The Administrator confirmed that M1 was prescribed to the Administrator and not R1. The Administrator stated that if they felt R1 was not doing well, they would have called 911. The Administrator stated that R1 was not feeling good for approximately 3-4 days before the Administrator called 911. The Administrator stated that they noticed that R1’s condition had changed completely on Sunday 11/30/2026. The Administrator stated that they were unable to recall how many total doses of M1 they administered to R1. The Administrator stated that they reviewed R1’s medical documentation and observed that R1 had a noted allergy to antibiotics and ceased administration of M1 after observing the documented allergy. The Administrator stated, “I know it's not right to give R1 the M1 without a prescription.”

CONTINUED ON LIC 9099C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20251205112600
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: LAUREL CANYON RESIDENTIAL CARE
FACILITY NUMBER: 195850612
VISIT DATE: 05/28/2026
NARRATIVE
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Record review revealed, upon EMS arrival on 12/01/2025, paramedics assessed R1 and determined R1 was bradycardic and hypotensive and transported to the hospital. At the hospital, R1 was diagnosed with multiple medical conditions that included Bradycardia, Thrombocytopenia, Hypothermia, Sepsis of an unspecified organism, Severe sepsis with septic shock, Respiratory failure, Pneumonia, Hyperosmolality, and Hypernatremia.

Interview with W1 revealed that R1 had been admitted to the hospital in critical condition. W1 stated when R1 arrived they had no identifying information for R1 and W1 had to contact the fire department to obtain R1's information. W1 reported that the emergency room doctor informed W1, based on the condition R1 was admitted in, R1 had clearly been neglected for several days prior to admission to the hospital. W1 stated that R1 had a dangerously low temperature of 83 degrees Fahrenheit and was barely responsive. R1 was also on multiple life-saving medications and measures for an extended period. R1 was discharged to a skilled nursing facility after a month in the hospital. W1 stated R1 required a lot of help, would not be able to be independent, and would require a long-term feeding tube.

Based on the information obtained during interviews and record review there is sufficient evidence to support the allegations of “Staff did not notice residents change in condition” and “Neglect/lack of supervision.” Therefore, the allegations are deemed Substantiated at this time. LPA informed the Administrator that an immediate civil penalty in the amount of $500 is being assessed on today’s date (05/28/2026) for a violation that resulted in the injury or illness of an individual in care. The Administrator was also informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f).

CONTINUED ON LIC 9099C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 29-AS-20251205112600
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: LAUREL CANYON RESIDENTIAL CARE
FACILITY NUMBER: 195850612
VISIT DATE: 05/28/2026
NARRATIVE
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The allegation of “Staff did not notify residents authorized representative of hospitalization” alleges that facility staff did not notify R1’s authorized representative of the 12/01/2025 hospitalization of R1. LPA conducted a file review for R1 and observed Individual #1 (I1) to be listed as R1’s emergency contact. LPA interviewed the Administrator and asked if I1 was notified of R1’s hospitalization within the required timeframe. The Administrator stated that the facility Assistant Administrator attempted to notify I1 of R1’s hospitalization at the time of the incident but did not receive any response. LPA interviewed the Assistant Administrator who stated that they attempted to notify I1 of R1’s hospitalization multiple times via telephone call and text message around the time R1 was hospitalized. The Assistant Administrator provided LPA with proof of a message sent to I1 by the Assistant Administrator on 12/11/2025. LPA reviewed the facility file and observed an incident report that was submitted to Community Care Licensing Division (CCLD) on 12/16/2025. LPA informed the Administrator and Assistant Administrator that a written report shall be submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of an incident which threatens the health, safety, or wellbeing of the resident. The Administrator and Assistant Administrator were unable to provide proof that they had contacted I1 or CCLD within the required timeframe. Based on interviews and record review there is sufficient evidence to support the allegation of “Staff did not notify residents authorized representative of hospitalization.” Therefore, the allegation is deemed Substantiated at this time.

The following deficiencies and civil penalty were cited/assessed (refer to LIC 9099Ds). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20251205112600
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: LAUREL CANYON RESIDENTIAL CARE
FACILITY NUMBER: 195850612
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2026
Section Cited
CCR
87464(f)(1)
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87464 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).
This requirement is not met as evidenced by:
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The Administrator agreed to conduct an in service training with all staff including the Administrator and Assistant Administrator about the importance of noticing the signs/symptoms of illness and seeking appropriate medical attention in a timely manner.
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Based on interview and record review the licensee did not comply with the section cited above as the facility did not provide appropriate timely care for R1's medical emergency which resulted in R1 being admitted to the hospital in critical condition which posed an immediate health concern to clients in care.
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The Administrator agreed to submit proof of the completed training to CCLD no later than POC due date.
Type A
05/29/2026
Section Cited
CCR
87466
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87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes....and that appropriate assistance is provided when such observation reveals unmet needs...This requirement is not met as evidenced by:
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The Administrator agreed to conduct an in service training with all staff including the Administrator and Assistant Administrator about the importance of noticing the signs/symptoms of illness and seeking appropriate medical attention in a timely manner.
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Based on interview and record review the licensee did not comply with the section cited above as the facility did not seek timely medical attention for R1 which resulted in R1 being admitted to the hospital in critical condition which posed an immediate health concern to clients in care.
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The Administrator agreed to submit proof of the completed training to CCLD no later than POC due date.
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: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20251205112600
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: LAUREL CANYON RESIDENTIAL CARE
FACILITY NUMBER: 195850612
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2026
Section Cited
CCR
87405(d)(1)
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87405 Administrator - Qualifications...
(d) The administrator shall have the qualifications specified...
(1) Knowledge of the requirements for providing care and supervision appropriate to the residents.
This requirement is not met as evidenced by:
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Administrator agreed to conduct four hours of medication administration training with all staff members that administer medications to residents including the Administrator and Assistant Administrator. Administrator agreed to submit proof of the completed training to CCLD no later than POC due date.
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Based on interviews and record review the licensee did not comply with the section cited above as the Administrator administered M1 to R1 when M1 was not prescribed to R1 and R1 had a documented allergy to M1 which posed an immediate health concern to clients in care.
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Type B
06/11/2026
Section Cited
CCR
87211(a)(1)
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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency...
(1) A written report shall be submitted to the licensing agency and to the person responsible...within seven days...
This requirement is not met as evidenced by:
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Administrator agreed to submit a statement of understanding confirming that they are aware of the reporting requirements timeframe and that they will adhere to the required timeframe when submitting future incident reports to CCLD no later than POC due date.
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Based on record review the licensee did not comply with the section cited above as the facility did not have proof that R1's responsible party or the department were notified of R1's 12/01/2025 hospitalization within the required timeframe which posed a potential safety risk to clients 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.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6