197603652-6-9-2025-31-AS-NGID-DHSRMT-20250619130913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603652
Report Date: 06/09/2025
Date Signed: 06/09/2025 11:11:49 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250514142748

FACILITY NAME:	AMBASSADOR GARDEN		FACILITY NUMBER:	197603652
ADMINISTRATOR:	SOFI DRUKER		FACILITY TYPE:	740
ADDRESS:	7324 CANBY AVENUE		TELEPHONE:	(818) 705-3404
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	158	CENSUS: 68	DATE:	06/09/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Sofi Druker, Administrator		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff neglect resulted in resident developing multiple pressure injuries.

INVESTIGATION FINDINGS:

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At 9:45 AM, Licensing Program Analyst (LPA), Huma Rahimi conducted an unannounced subsequent complaint visit. LPA met with the staff Kristina Papazyan and the Administrator Sofi Druker was contacted and arrived shortly after. LPA disclosed the reason for the visit.

An initial visit was conducted on 05/15/2025. At 10:20 AM, LPA requested resident and staff roster. At approximately 10:30 AM, LPA conducted a physical plant tour of the facility. At 10:50 AM, LPA requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, Staff Training, etc., relevant to the investigation. Between 11:00 AM – 1:55 PM, LPA interviewed the Administrator and eight (8) residents. During today's visit, at 10:45 AM, LPA also interviewed Staff #1 (S1).

Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025

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 31-AS-20250514142748

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMBASSADOR GARDEN	FACILITY NUMBER: 197603652
	VISIT DATE: 06/09/2025

NARRATIVE

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Staff neglect resulted in resident developing multiple pressure injuries.
It is alleged that the facility staff neglected Resident #1 (R1) which resulted in developing multiple pressure wound injuries in the buttocks area with emitting pus and was not receiving home health or hospice services. To investigate this allegation LPA conducted an interview with the Administrator who denied ever retaining a resident with a prohibited health condition. The Administrator also informed LPA that R1 is receiving home health services since his/her admission to the facility and the treatment for the redness on the buttock area since 04/24/2025. However, on 05/12/2025 a small opening was observed by the facility staff on R1’s buttocks area which was immediately reported to R1’s Primary Care Physician (PCP). Subsequently, R1’s PCP advised the Administrator to take R1 to the hospital emergency room (ER) for further evaluation. On 05/13/2025, R1 was transported to ER and R1 was discharged the same day from the hospital. On 05/16/2025, LPA requested and reviewed R1’s hospital medical records and did not observe any medical information to conclude R1’s pressure wound injuries stage. The medical records indicated that R1 has a small ulceration with no necrosis or eschar. Lastly, interviews with R1 and seven (7) other residents revealed that they are happy with the care being provided by the facility staff and never felt neglected. No sufficient evidence was obtained, thus based on interviews and record review this allegation is deemed Unsubstantiated at this time.

Exit Interview Conducted. A copy of this report provided.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2025

LIC9099 (FAS) - (06/04)

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