197608084-7-22-2026-31-AS-NGID-DWEP2Y-20260728105642

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608084
Report Date: 07/22/2026
Date Signed: 07/22/2026 03:08:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/17/2025 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20250317085251

FACILITY NAME:	OUR SWEET HOME INC #3		FACILITY NUMBER:	197608084
ADMINISTRATOR:	ARUTYUNYAN, TINA		FACILITY TYPE:	740
ADDRESS:	21054 VINTAGE ST		TELEPHONE:	(818) 960-5224
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	6	CENSUS: 6	DATE:	07/22/2026
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Semy Reyes, Staff		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Facility staff did not assist with medications as prescribed.

INVESTIGATION FINDINGS:

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At 11:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted subsequent complaint visit to deliver the final report. Upon arrival, the LPA was granted access to the facility by Staff #1 (S1). LPA contacted the Administrator, Tina Arutyunian, and explained the reason for the visit. LPA was infromed that the Administrator will not be able to come in and designated S1 to sign for the report.

LPA requested residents and staff rosters. LPA also conducted a physical plant tour to ensure health and safety of the residents are protected.

On 03/18/25, LPA initiated the complaint visit. During that visit LPA requested resident and staff roster. At 9:15am requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, Medication Policy, Centrally Stored Medication and Destruction Record (CSMDR), Medication Administration Record (MAR), Hospice Plan of Care,
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

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-20250317085251

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: OUR SWEET HOME INC #3	FACILITY NUMBER: 197608084
	VISIT DATE: 07/22/2026

NARRATIVE

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Staff Training, relevant to the investigation. Between 9:30am - 10:30am, LPA conducted an interview with the Administrator, two (2) staff and attempted to interview five (5) out of five (5) residents.

Additionally, LPA requested R1's Medical Records from Northridge Hospital and Convalescent Hospital/Skilled Nursing Facility (SNF).

Allegation: Facility staff did not assist with medications as prescribed.

To investigate this allegation, LPA conducted an interview with the Administrator, staff and residents. LPA also conducted reviews of R1’s Centrally Stored Medication and Destruction Records (CSMDR). Upon review of documentation, LPA observed that R1 was admitted to this facility on (08/11/2022) with the prescription of antipsychotic medication (50MG) and through review of medical documentation from 08/11/2022 to 01/18/2023, it appears that R1 was receiving their medication as prescribed. On 01/18/2023, the hospice physician increased R1’s antipsychotic dosage, adding a 100MG tablet at bedtime to the existing 50MG daily dose. After R1’s hospitalization from 02/11/2024 to 02/23/2024, the hospital physician discontinued the 50MG dose and continued only the 100MG antipsychotic medication once daily. Furthermore, R1’s records show that between 03/15/2024 – 05/31/2024, R1 was admitted to Rinaldi Convalescent Hospital and continued taking the prescribed medication during that time. R1’s antipsychotic medication was discontinued after their discharge on 05/31/24, based on the Convalescent Hospital physician’s order, and records confirmed it was not administered until a new hospice physician order was issued on 11/18/24. All documentation reviewed—including CSMDR records, physician orders, and medication logs—showed proper, accurate, and authorized administration. Medication checks for four (4) additional residents also showed no errors. Although there were concerns regarding hospice administration and prescribing authority, the investigation did not reveal evidence that facility staff failed to assist R1 with medications as prescribed. Based on interviews, records reviews and medications examined/inspected, there is insufficient evidence to support the above allegation. Therefore, this allegation is deemed Unsubstantiated, at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026

LIC9099 (FAS) - (06/04)

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