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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608986
Report Date: 10/16/2025
Date Signed: 10/16/2025 03:17:33 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
08/25/2025 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20250825222044
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:
10/16/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lala SoghomonyanTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not provide adequate food service for resident

Staff did not ensure that resident's hygiene needs were met

Staff confined resident to their room

Staff yelled at resident
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 and arrived at approx. 11:10 a.m.

On 09/02/2025, from 11:29 a.m. to 05:15 p.m., LPA Conway conducted an initial 10-day complaint visit to investigate the allegations listed above. At approximately 11:30 a.m., the LPA conducted a physical plant tour, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. Today LPA's conducted physical plant, interviewed staff and residents as well as reviewed and obtained copies of additional pertienent records relevant to the investigation.

It was reported that “Staff did not provide adequate food service for resident” as it was alleged that Resident #1 (R1) was only fed once a day and was denied drinking water when the requested.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
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-20250825222044
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: 10/16/2025
NARRATIVE
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Interviews conducted on 09/02/2025, with Four (4) residents in care revealed that three (3) out of four (4) resident stated they were not provided a sufficient amount of meals daily and at times were denied a glass of water when requested. One (1) resident did not express any concerns with food. During the Annual Continuation inspection of the physical plant conducted on 09/04/2025, between 9:30 a.m. and 5:15 p.m., LPAs Balisi and Arroyo observed that the facility did not have an adequate supply of perishable and non-perishable food stored in either the refrigerator or the pantry closet located near the door.
During today’s physical plant LPA’s observed fresh produce, frozen protein, bread, tortillas and various products used for food preparation properly stored. LPA’s interviews with the (2) residents currently in care revealed that each resident did not express any concerns for food service. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Staff did not provide adequate food service for resident” has been deemed Substantiated at this time.

It was reported that “ Staff did not ensure that resident’s hygiene needs were met”, as it was alleged R1 has not received a shower. Interviews conducted on 09/02/2025, with four (4) residents in care revealed that all (4) have had concerns with availability of personal hygiene items such as soap, shampoo, and laundry detergent. During a Case management – Deficiencies visit conducted on 10/13/2025 between 09:40 a.m. and 03:00 p.m. LPAs Balisi and Arroyo observed that the facility did not have an adequate supply of paper towels and laundry detergent. During today’s physical plant LPA’s did not observed an adequate supply of paper towels. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not ensure that resident's hygiene needs were met ” has been deemed Substantiated at this time.

It was reported that "Staff confined resident to their room", as it was alleged that R1 was not allowed to walk outside of their room. Interviews conducted on 09/02/2025, with four (4) residents in care revealed concerns regarding being confined to their rooms. Three (3) of the four (4) residents reported that the hallway door separating the bedroom areas from the common area was observed to be closed and locked on multiple occasions. One (1) resident, who requires assistance transferring in and out of bed, reported not receiving the necessary support from staff. Another resident, who is legally blind, stated that staff did not provide assistance with safely ambulating throughout the facility.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250825222044
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: 10/16/2025
NARRATIVE
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Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff confined resident to their room” has been deemed Substantiated at this time.

It was reported that “Staff yelled at resident”, as it was alleged that R1 was yelled at by staff for using the bathroom. Interviews conducted 09/02/2025, with four (4) residents in care revealed concerns regarding former staff. All (4) residents reported concerns that previous Staff #1 (S1) spoke to residents in an unpleasant manner and did not treat them with dignity and respect when residents would make requests for food, water or personal hygiene items. LPA’s interviews with the (2) residents currently in care revealed they did not express any concerns with the current staff on shift. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff yelled at resident” has been deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D). Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Administrator left during the visit to attend to a personal matter and stated they would not be able to return to the visit. Licensee was contacted and stated they are unable to be onsite.

Exit interview conducted with Staff and Licensee, appeal rights discussed, and a copy of this report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250825222044
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: 10/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2025
Section Cited
CCR
87468.1(a)(6)
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To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...or barring windows against intruders, with permission from the Department. This requirement was not met as evidenced by:
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Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance then send to LPA via email by COB 10/17/2025.
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Based on interviews, the licensee did not comply with the section cited as it was reported that residents were confined to their room on multiple occasions which poses an immediate health, safety and personal rights risk to residents in care.
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Type A
10/17/2025
Section Cited
CCR
87468.1(a)(1)
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To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:
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Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance then send to LPA via email by COB 10/17/2025.
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Based on interviews, the licensee did not comply with the section cited as it was reported that residents were not treated with dignity and respect by S1 on multiple occasions, which poses a poses an immediate health, safety and 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: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250825222044
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: 10/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2025
Section Cited
CCR
87555(b)(1)
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Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day...Not more than fifteen (15) hours shall elapse between the third and first meal. This requirement is not met as evidenced by:
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Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance then send to LPA via email by COB 10/24/2025.
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Based on observations and interviews, the licensee did not comply with the section cited as meals were not provided to residents in a timely manner and a sufficient amount of food was not observed to be stored, which poses a potential, health, safety and personal rights risk to residents in care.
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Type B
10/24/2025
Section Cited
CCR
87464(4)
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Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living... as specified in Section 87608, Postural Supports. This requirement is not met as evidenced by:
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Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance then send to LPA via email by COB 10/24/2025.
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Based on observations and interviews, the licensee did not comply as a sufficient supply of personal hygiene items were not observed and residents were not provided assistance with showering which poses a potential, health and 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: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5