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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608986
Report Date: 07/10/2025
Date Signed: 07/10/2025 02:27:32 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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/06/2024 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20241206160956
FACILITY NAME:AGE WELL ASSISTED LIVING FACILITYFACILITY NUMBER:
197608986
ADMINISTRATOR:LALA SOGHOMONYANFACILITY TYPE:
740
ADDRESS:15149 SYLVAN STREETTELEPHONE:
(818) 666-1665
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY:6CENSUS: 5DATE:
07/10/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Tamara BorisovnaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Licensee does not ensure that resident is being provided an adequate amount of food while in care.

Staff are unable to communicate with resident in care due to language barrier.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent unannounced complaint visit to deliver findings. Upon arrival LPA met with staff and explained the reason for the visit. Licensee Sarkis Dovlatyan and Assistant Administrator Iveta Darabedym were all contacted and each stated they were unable to be onsite for the visit due to unforseen circumstances. Administrator Lala Soghomonyan was out of town during the visit. Licensee and Assistant Admin stated staff Tamara Borisovna could sign in their place.

On 12/12/2024, the initial complaint visit was conducted by LPA between approximately 10:00 a.m. - 11:30 a.m. During the visit, LPA’s conducted physical plant, interviewed staff, residents as well as reviewed and obtained copies of pertinent documentation relevant to the investigation.

It was reported that "Licensee does not ensure that resident is being provided an adequate amount of food while in care" , as it was alleged that Resident #1 (R1), did not get enough food and did not have a variety of food while they resided at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
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 2
Control Number 29-AS-20241206160956
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: AGE WELL ASSISTED LIVING FACILITY
FACILITY NUMBER: 197608986
VISIT DATE: 07/10/2025
NARRATIVE
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Interviews conducted with one (1) out of three (3) residents in care revealed that they are satisfied with the food they receive because of the variety, which included soup, sandwiches, burgers, tacos and rice plates. (1) resident did not want to interview and the other resident was sleeping at the time of the visit.

LPA's interview with staff revealed typical meals include Oatmeal with fresh fruit and toast for breakfast, hot dog, sandwiches, tacos, burgers, soup, chicken , sauteed vegetables for lunch and dinner. A family member of R1 would also visit approximately once a week and provide specific foods that R1 requested and staff would cook it for R1. Staff continued to state that R1 never missed a meal while they resided at the home. During physical plant, LPA observed a sufficient amount of perishable and non-perishable food properly stored. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “licensee does not ensure that resident is being provided an adequate amount of food while in care” is deemed Unsubstantiated at this time.

It was reported that "Staff are unable to communicate with resident in care due to language barrier " as
It was alleged that facility staff had difficulty communicating with R1 while they resided at the facility because R1 primarily speaks Spanish. Interviews with the complainant and facility staff indicated that R1 spoke limited English but communicated most effectively in Spanish. R1 was able to follow simple instructions and express some needs. Additionally staff stated they were able to communicate with R1, to inform them when meals were ready, check on their well-being, or ask if they needed help. Staff made use of a translation app only to have conversations with R1. Staff did not recall R1 raising any immediate or potential concerns during their time at the facility. During interviews, one of the three residents interviewed stated they had no issues communicating with R1. One (1) resident declined to be interviewed and the other resident was sleeping. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Staff are unable to communicate with resident in care due to language barrier” is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2