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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850632
Report Date: 05/14/2026
Date Signed: 05/14/2026 06:13:46 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
05/04/2026 and conducted by Evaluator Christine Yee
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20260504151844
FACILITY NAME:GOLDEN YEARS ASSISTANCE LIVING, INCFACILITY NUMBER:
195850632
ADMINISTRATOR:KARAPETYAN, KARINEFACILITY TYPE:
740
ADDRESS:15013 MARLIN PLTELEPHONE:
(606) 600-0006
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:6CENSUS: 6DATE:
05/14/2026
UNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH:Ovsanna Khayalyn, Corporate OfficerTIME COMPLETED:
06:20 PM
ALLEGATION(S):
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1. Staff did not provide assistance to resident as needed
2. Staff did not provide resident's records to emergency personnel in a timely manner
3. Staff did not maintain facility clean
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and was allowed entry into the home by Stella Gevorkova, Staff. Staff contacted Ovsanna Khayalyn, Corporate Officer and she arrived at 11:13am to conduct the visit. The reason for today's visit was provided.

On today's visit, LPA Yee conducted interviews with Ovsanna Khayalyn at 1:38pm, Staff #1 at 2:29pm, attempted to interview Resident #1 at 3:19pm and reviewed and obtained copies of facility records throughout the visit. A tour of the facility, inside and outside, was also conduted at 1:08pm.

Per information received from interviews conducted regarding the allegation that staff did not provide

continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
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 3
Control Number 29-AS-20260504151844
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: GOLDEN YEARS ASSISTANCE LIVING, INC
FACILITY NUMBER: 195850632
VISIT DATE: 05/14/2026
NARRATIVE
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Page 2.

assistance to resident as needed, the investigation revealed that on the morning of May 4, 2026, around 8:00am or 8:15am, Staff #1 had finished changing Resident #1's diaper and had taken the soiled diaper to the outside trash can and returned to the room to prop the resident up in bed, in preparation tor feeding the resident breakfast. Upon entry into the room, Staff #1 observed the resident having a spasm, with mouth open and eyes rolling backwards. Staff #1 immediately called Ovsanna Khayalyn and placed the phone on speaker mode and started chest compressions on Resident #1. Per information provided, Laura Garcia, Licensee, called 911 and Ovsanna Khayalyn jumped in her vehicle and headed to the facility. Ovsanna Khayalyn lives close by and arrived at the facility at the same time as paramedics.

Per Staff #1, Resident #1 who was already laying flat on the bed due to the diaper change had difficulty breathing but after administering about 10-15 chest compressions the resident opened their eyes, mouth relaxed back to normal and coughed about 2 to 3 times. Per Staff #1, they did elevate the resident slightly but emergency personnel and Ovsanna had arrived at the facility and they stepped out of the room. Per Staff #1, they observed the paramedics putting a arm cuff on the resident and transferred the resident on to the gurney and taken outside. All this happened very quickly. The paramedics were outside for about 5 minutes while they waited for hospital information. Based on the information obtained, there is insufficient evidence to support the allegation that staff did not provide assistance to resident as needed, therefore the allegation is unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur.

Per information provided by Ovsanna Khayalyn regarding the allegation that staff did not provide resident's records to emergency personnel in a timely manner, she has a separate emergency folder created for each resident. The emergency folder for Resident #1 contains a copy of the Identification and Emergency Contact Information, a copy of the Driver License, a list of medications and the notes from the last medical visit conducted on 3/11/26. Per Ovsanna Khayalyn, she immediately provided the prepared folder to the

Continued on LIC9099-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260504151844
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: GOLDEN YEARS ASSISTANCE LIVING, INC
FACILITY NUMBER: 195850632
VISIT DATE: 05/14/2026
NARRATIVE
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Page 3.

paramedics without them having to request it. There was no delay in providing any documents. Based on the information obtained, there is insufficient evidence to support the allegation that Staff did not provide resident's records to emergency personnel in a timely manner, therefore the allegation is unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur.

A tour of the facility, inside and outside, was conducted to inspect the common areas, all three resident bedrooms, common bathroom and the outside areas at 1:08pm to investigate the allegation that staff did not maintain facility clean. Per tour of the common areas, bedrooms and outside areas, LPA Yee observed that all the areas inspected were clean and well maintained. There were no urine or body fluids or any odors observed on today's visit. Residents were also observed to be clean and doing well. Based on the information obtained, there is insufficient evidence to support the allegation that Staff did not maintain facility clean, therefore the allegation is unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur.


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: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3