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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608986
Report Date: 10/13/2025
Date Signed: 10/13/2025 02:37:55 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
08/12/2025 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20250812110937
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: 2DATE:
10/13/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Samaria ReedTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff is not following resident's care plan.

Staff leaves resident in bed for extended periods of time.

Staff confiscated resident's wheelchair and walker.

Staff are unable to communicate with resident due to language barrier.

Facility kept incomplete resident files.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA's) Brian Balisi and Martha Arroyo conducted a subsequent complaint visit to investigate the allegations list above. During today’s visit, LPA met with staff and explained the reason for the visit. Administrator Lala Soghomonyan was contacted , but they stated they were unable to be at the facility until the afternoon. Licensee Sarkis Dovlatyan was contacted and stated they were unable to be at the facility until the afternoon, but will contact Lala to ensure they are able to be present.
On 08/19/2025, from 10:00 a.m. to 03:00 p.m., LPA Balisi conducted an initial 10-day complaint visit to investigate the allegation listed above. At approximately 10:00 a.m., the LPA conducted a physical plant tour, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation.

It was reported that "Staff is not following resident's care plan", "Staff leaves resident in bed for extended periods of time" and “Staff confiscated resident’s wheelchair and walker” as It was alleged that Resident #1 (R1) requires assistance with bathing and transferring out of bed;
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
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-20250812110937
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: 10/13/2025
NARRATIVE
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however, staff have not been providing this assistance. Interviews conducted and records review revealed that R1’s physician’s report indicates R1 needs help with bathing, dressing, toileting, and is unable to transfer in and out of bed without assistance. During interviews, R1 and Resident #2 (R2), R1’s roommate since approximately July 2025, stated that R1 only began receiving help with bathing and showers toward the end of August 2025. Prior to that, staff had not been assisting R1 with bathing or showering. Additionally, interviews revealed that R1’s wheelchair is typically stored in the closet and only brought out for medical appointments. Interviews further revealed that staff have not encouraged or assisted R1 in getting out of bed. LPA’s interviews with staff and the facility administrator denied restricting R1’s use of the wheelchair and stated that R1 has not requested to use it within the facility. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Staff is not following resident’s care plan”, “Staff leaves resident in bed for extended periods of time” , and “Staff confiscated resident’s wheelchair and walker” have been deemed Substantiated at this time.

It was reported that “Staff are unable to communicate with Resident due to language barrier” as it was alleged that R1 has difficulty communicating with Staff. LPA’s interview conducted with Interviews conducted with three (3) residents in care revealed that all (3) residents stated they could only communicate with Staff #1 (S1) through use of a translating app on staff's phone. Interview with R1 stated they need staff to speak into R1’s phone for communication, but staff are unable to effectively communicate. The (3) residents did not express any immediate concerns for their health and safety as staff are able to provide basic services, but each did express potential concerns that if there was an emergency they would not be able to communicate with the emergency personnel. LPA’s interview with S1 revealed that S1 was able to communicate with LPA through a translation app. While using translating app, S1 was able to communicate regarding facility business and resident care needs and they stated they would contact the Administrator in the event of an emergency. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that “Staff are unable to communicate with Resident due to language barrier” has been Substantiated at this time.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 29-AS-20250812110937
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: 10/13/2025
NARRATIVE
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Continued from 9099-C

It was reported that “Facility kept incomplete resident files” as it was revealed during a file review for R1 on 08/19/2025, that files were not fully completed including Preplacement Appraisal (LIC 603), Resident Appraisal (LIC 603A), Appraisal / Needs and Services Plan (LIC 625), and Physician’s Report (LIC 602). Administrator stated they could not recall why forms were incomplete, but will work on getting them completed. On 09/04/2025, during an Annual Continuation Visit, LPA's records review revealed three (3) resident files were observed to be incomplete along with R1. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that “Facility kept incomplete resident files” has been Substantiated at this time.

Civil penalties in the amount of $500 are assessed today for repeat violations. The Licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f).

Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D).

Administrator contacted LPAs at approx 01:57 p.m. and stated they were unable to be onsite during the visit, but stated staff will sign in their place. Licensee stated they were unable to be onsite. LPA conducted exit interview with Licensee over the phone along with staff onsite, appeal rights discussed, and a copy of this report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250812110937
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: 10/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/14/2025
Section Cited
CCR
87464(a)
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The services provided by the facility shall be conducted so as to continue and promote, to the extent possible... both in the facility and in the community. This requirement was not met as evidenced by:
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Licensee agreed to ensure full facility files are kept onsite, conduct training with staff on how to use files and provide a written plan on how they will ensure future compliance, then send to LPA via email by COB 10/14/2025.
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Based on interviews and records review, the Licensee failed to complete resident files, preventing staff from following proper care plans, which posed an immediate health, safety, and personal rights risk to residents in care.
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Type B
10/24/2025
Section Cited
CCR
87468.2(a)(1)
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To have a reasonable level of personal privacy in accommodations... communications, telephone, conversations... meetings of resident and family groups.
This requirement was not met as evidence by:
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Licensee provided an updated LIC 500, and agreed to review section cited and ensure to have staff scheduled that can communicate with residents in care and outside agencies. Licensee also agreed to submit statement of understanding via email to CCL by COB 10/24/2025.
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Based on interviews and observations, the licensee did not ensure there was staff scheduled who can communicate with residents that they can fluently communicate with, which poses a potential personal rights and 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: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250812110937
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: 10/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2025
Section Cited
CCR
87506(a)
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The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by:
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 Licensee agreed to ensure full facility files are kept onsite and provide a written plan on how they will ensure future compliance, then send to LPA via email by COB 10/14/2025.
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Based on interviews and records review the licensee did not comply with the section cited above as (4) out of (4) records reviewed were not fully completed, which poses a potential health safety or personal rights 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: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5