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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608986
Report Date: 09/04/2025
Date Signed: 09/04/2025 04:53:16 PM

Substantiated


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
06/25/2025 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20250625100817
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: 4DATE:
09/04/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Lala SoghomonyanTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility retained resident with a prohibited health condition.
Staff handle residents in an aggressive manner.
Staff does not ensure that resident is being provided an adequate amount of food while in care.
Staff does not ensure resident's bathing needs are being met.
Staff does not ensure resident's incontinent needs are met.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Brian Balisi, Martha Arroyo along with Licensing Program Manager (LPM) Desaree Perera conducted an unannounced subsequent complaint visit to this facility in conjunction with an Annual Continuation visit. Upon arrival, LPAs and LPM met with staff Jesusito “Jay” Banawa. The administrator, Lala Soghomonyan, arrived shortly after. The reason for the visit was explained. Entrance interview conducted.

On 06/27/2025, LPA Balisi conducted an unannounced initial complaint visit. During the visit, LPA met with licensee Sarkis Dovlatyan. During the visit, at approx. 12:50 p.m. LPA conducted a tour of the physical plant, interviewed staff, resident, reviewed and obtained copies of pertinent documentation relevant to the investigation.

Report continued on LIC 9099...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
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 5
Control Number 29-AS-20250625100817
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: 09/04/2025
NARRATIVE
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Report Continued from LIC 9099...

During today’s visit, LPAs and LPM conducted a tour of the physical plant, interviewed residents, staff, administrator and licensee between 9:40 a.m. – 12:00 p.m. Additionally, LPAs reviewed and obtained documents related to the investigation.

It was alleged that the “facility retained a resident with prohibited health conditions”. It was further reported that Resident #1 (R1) had multiple sores on R1s arms, buttocks and legs including an open sore. During the investigation, LPA requested the facility file for R1, however, the administrator was unable to provide any documentation pertaining to R1. However, during today’s visit, LPAs and LPM observed Resident #2 (R2) at the facility with a prohibited health condition. LPAs and LPM interview with administrator reflected that R2 does not have any Home Health (HH) services at this time. Per staff, R2 will be evaluated for hospices services. Based on the information gathered during the course of the investigation, the Department has sufficient evidence to determine the “facility retained a resident with prohibited health condition,” therefore, the above allegation is deemed SUBSTANTIATED at this time.

It was alleged that “Staff #1 (S1) treats residents in an aggressive manner”. It was reported that S1 yells, hits and treats residents in an aggressive manner. Interviews conducted during the course of the investigation reflected that S1 did in fact treat residents in an aggressive manner. S1 would yell, and did not allow residents to speak with each other, leave their bedrooms or eat outside. Interviews further reflected that S1 was also seeing hitting resident however, no injuries were noted. Based on information gathered during the course of the investigation, the Department has sufficient evidence to determine S1 treated residents in an aggressive manner, therefore, the above allegation “Staff #1 (S1) treats residents in an aggressive manner” is deemed SUBSTANTIATED at this time.

It was also alleged “Staff does not ensure that resident is being provided an adequate amount of food while in care.” Information gathered during the course of investigation reflected residents were only receiving one meal until approximately 2 days ago. Furthermore, during today’s visit, LPAs and LPM did not observe a sufficient amount of perishable and non-perishable food available to the residents. Additionally, during today’s visit, at approximately 1:00 p.m., LPAs and LPM did not observe staff preparing lunch for residents.

Report Continued on LIC 9099C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250625100817
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: 09/04/2025
NARRATIVE
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Report Continued from LIC 9099C...

The administrator nor staff were unable to respond as to why lunch was not being prepared and what was on the menu for lunch. LPM requested that the administrator prepare lunch for all residents immediately. Based on all information gathered during the course of the investigation, the Department has sufficient evidence to determine that staff did not provide an adequate amount of food for residents. Therefore, the above allegation “Staff does not ensure that resident is being provided an adequate amount of food while in care” is deemed SUBSTANTIATED at this time.

It was alleged that “Staff does not ensure resident's bathing needs are being met.” It was reported that staff did not assist R1 with showers. During the course of the investigation, LPA was unable to speak to R1 due to R1 no longer residing in the facility. However, during interviews conducted during today’s visit, it was determined that Resident #3 (R3) was not showered for a prolonged period of time. Interviews further reflected that the facility staff does not assist R3 with showers, toileting, or grooming and R3 only receives showers from HH twice a week. Based on the information gathered, the Department has sufficient to determine that residents are not receiving basic services such as bathing or grooming. Therefore, the above allegation, “Staff does not ensure resident's bathing needs are being met” is deemed SUBSTANTIATED at this time.

It was also alleged that “Staff does not ensure resident's incontinent needs are met” as residents were being left soiled for an extended period of time. During today’s visit, LPAs and LPM did not observe any residents who currently use diapers. However, LPAs and LPM were informed that R3 has an indwelling urinary catheter and staff empty the bag without appropriate training from a skilled professional. Furthermore, it was reflected that R3 has had numerous UTIs due to the catheter not properly being cared for. Moreover, staff were unaware of who to contact or who provided R3 assistance with the catheter care. Based on the information gathered during the course of the investigation, the Department has sufficient evidence to determine residents did not receive proper incontinent care. Therefore, the above allegation, “Staff does not ensure resident's incontinent needs are met” is deemed SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC9099-D). Additional citations observed during this complaint investigation was cited on the Annual continuation visit.

Exit interview conducted, appeal rights discussed, and a copy of this report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250625100817
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2025
Section Cited
CCR
87631(a)(1)
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(a)Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: (1) When care is performed by or under the supervision of an appropriately skilled professional. This requirement is not met as evidenced by:
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Administrator agreed to review regulation cited and submit a statement of understanding, along with a written plan to ensure future complaince and send to LPA via email by COB 09/05/2025.
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Based on interviews and observations, licensee did not comply with the section above by retaining a resident (R2) with pressure injuries with no appropriately skilled professional providing care to the sore, which poses an immediate health, and safety risk to resident in care.
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Type A
09/05/2025
Section Cited
CCR
87464(f)(3)
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(f) Basic services shall at a minimum include: (3) Three nutritionally well-balanced meals and snacks made available daily, including low salt or other modified diets prescribed by a doctor as a medical necessity, as specified in Section 87555, General Food Service Requirements. This requirement is not met as evidenced by:
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Administrator agreed to review regulation cited and submit a statement of understanding, along with a written plan to ensure future complaince and send to LPA via email by COB 09/05/2025.
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Based on observation and interviews, licensee did not comply with the above section due to residents only receiving one (1) meal for a period of time, which poses an immediate health and safety risk to residents 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: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250625100817
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2025
Section Cited
CCR
87464(f)(4)
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(f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement is not met as evidenced by:
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Administrator agreed to review regulation cited and submit a statement of understanding, along with a written plan to ensure future complaince and send to LPA via email by COB 09/05/2025.
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Based on interviews, licensee did not comply with the above section by not providing residents basic services such as bathing and grooming which poses a immediate health and safety risk to residents in care.
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Type A
09/05/2025
Section Cited
CCR
87623(b)(1)
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b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (1) Ensuring that insertion and irrigation of the catheter shall be performed by an appropriately skilled professional.…This requirement is not met as evidenced by:
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Administrator agreed to review regulation cited and submit a statement of understanding, along with a written plan to ensure future complaince and send to LPA via email by COB 09/05/2025.
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Based on interviews and record review, licensee did not comply with the section above by not ensuring an appropriately skilled professional provided care to R3s catheter, which poses an immediate health and safety risk to resident 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: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5