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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608986
Report Date: 10/31/2025
Date Signed: 10/31/2025 12:58:28 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
07/16/2025 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20250716115150
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:
10/31/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Devid DavydovTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not provide proper first aid treatment to resident in care
Staff yelled at residents in care
Staff did not meet the residents' diapering care needs in a timely manner
Staff did not clean resident's room
Staff did not provide laundry services to resident in care
Staff did not provide nutritious meals to residents in care
Staff did not provide proper medication assistance to residents in care
Facility is malodorous
INVESTIGATION FINDINGS:
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**This is the amended report to update information. The intial report was delivered 10/13/2025 and 07/21/2025***Licensing Program Analysts (LPA) Brian Balisi 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. Licensee stated they would be onsite shortly.
On 07/21/2025, from 09:45 a.m. to 03:45 p.m., LPA Balisi conducted an initial 10-day complaint visit to investigate the allegations 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. On 09/04/2025, from 09:30 a.m. – 05:15 a.m., LPA’s Balisi, Arroyo and LPM Perera conducted physical plant, interviewed four (4) residents, and staff while on site for a separate investigation. On 10/13/2025, from 09:40 a.m. to 03:00 p.m. LPAs Balisi and Arroyo conducted a subsequent complaint visit. LPA’s conducted physical plant, interviewed staff, residents and reviewed and obtained copies of additional pertinent documentation relevant to the investigation
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
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 8
Control Number 29-AS-20250716115150
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: 10/31/2025
NARRATIVE
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continued from 9099
It was reported that “Staff did not provide proper first aid treatment to resident in care” as it was alleged that Resident #1 (R1) fell and was not provided first aid or care in a timely manner. Interviews conducted and records review revealed on 07/15/2025, R1 fell in the hallway near the bathroom. LPA’s interview with Staff #1 (S1) revealed they assisted R1 back to their room and offered R1 some ice, but R1 declined. S1 also stated they did not inform the Administrator or offer to call 911 after the fall. Additionally LPA’s interview with R1 revealed that although they did not feel like they were in any pain after the fall, staff only offered minimal assistance. The next day R1 decided to admit themselves into a local hospital. 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 proper first aid treatment to resident in care” has been deemed Substantiated at this time.

It was reported that "Staff yelled at residents in care" , as it was alleged that when resident’s requests assistance staff speak to them in inappropriate manner. Interviews conducted with five (5) residents in care revealed all (5) residents have observed S1 respond back to them in an inappropriate manner when requesting assistance with basic services such as food, toileting and transferring. LPA’s interview with S1 and Administrator revealed they denied ever speaking to residents in an inappropriate manner. Based on information gathered during the investigation the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Staff yelled at residents in care” is Substantiated at this time.

It was reported that "Staff did not meet the residents' diapering care needs in a timely manner" as it was alleged that residents are left in soiled diapers due to staff not changing them in a timely manner. Interviews conducted with five (5) residents during the complaint investigation revealed that Resident #2 (R2) routinely requested diaper changes or for their Foley catheter bag to be emptied, but these requests were not addressed in a timely manner. Residents, including R2, reported that R2’s catheter bag was frequently more than half full. Additionally, R2 stated they do not have regular bowel movements; however, when they did, S1 often delayed responding to requests for assistance, sometimes for more than 10 minutes. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not meet the residents' diapering care needs in a timely manner"” has been deemed Substantiated at this time
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 29-AS-20250716115150
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: 10/31/2025
NARRATIVE
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continued from 9099-C
It was reported "Staff did not clean resident's room", as it was alleged that R1 has not had their bedding changed and staff have not swept since they moved in. Interviews conducted with five (5) residents in revealed (4 ) out of (5) residents have experienced not having their bed sheets changed for a prolonged period of time while (1) resident stated they have had their bed sheets changed in a timely manner. Furthermore all (5) residents stated they have not observed S1 proactively attempt to keep their rooms clean as they have had to request S1 to empty trash or dust and wipe down hard surfaces. During physical plants , LPA’s have observed food particles near dining table and overflowing trash cans on multiple occasions. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not clean resident’s room” has been deemed Substantiated at this time.

It was reported that, that "Staff did not provide laundry services to resident in care", as it was alleged that R1 has not had their laundry service since they moved in. Interviews conducted with five (5) residents in care revealed (4) out of (5) residents have had concerns with their laundry not being completed in a timely manner or not being completed at all. Furthermore residents stated on several occasions staff informed them they would complete their laundry, but they never did and on another occasion residents stated there was no laundry detergent available. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not provide laundry services to resident in care” has been deemed Substantiated at this time

It was reported that "Staff did not provide nutritious meals to residents in care" as it was alleged that residents are not provided with 3 nutritious meals a day. Interviews conducted with five (5) residents revealed all (5) have had concerns with meal services stating that on multiple instances food was not provided in a timely manner, food was not provided according to a residents special diet, and there was not a variety of food served. During physical plants over the course of the investigation, LPA’s have not observed a sufficient supply of perishable and non-perishable food properly stored on multiple visits. On 09/04/2025, during an annual inspections, LPA did not observe staff prepare lunch in a timely manner for residents in care. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not provide nutritious meals to residents in care” has been deemed Substantiated at this time.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 29-AS-20250716115150
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: 10/31/2025
NARRATIVE
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Continued from 9099-D
It was reported that “ Staff did not provide proper medication assistance to residents in care”, as it was alleged that R1 was allowed to obtain their own medications from the medication cabinet and administer themselves. Interviews revealed that R1 was allowed access to their medication, which was stored in a medication cabinet located in the kitchen, upon request. On 07/10/2025, between approximately 9:46 a.m. and 3:00 p.m., during a separate complaint investigation (Complaint Control #29-AS-20250709155231), LPA observed R1’s medications being stored in R1’s room. During that same visit, staff relocated the medications to the designated centrally stored medication area. In an interview, Staff #1 (S1) stated that R1 would become agitated if not given access to their medications at the time of administration, so staff permitted R1 to access their medication as needed. On 09/04/2025, during an annual inspection visit, LPA observed medications stored in Resident #2 (R2)’s room. . During that same visit, staff relocated the medications to the designated centrally stored medication area. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not provide proper medication assistance to residents in care” has been deemed Substantiated at this time.

It was reported that facility is malodorous, as it was alleged that the facility smelled like urine due to staff not keeping the facility well maintained. Interviews conducted with five (5) residents in care revealed that all (5) residents have had concerns with S1 not being proactive in keeping facility clean and free from smells. Furthermore (3) out of (5) residents stated they have observed the smell of urine and they believe it is due to staff not changing R2’s urine bag in a timely manner. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “facility is malodorous” has been deemed Substantiated at this time.

Civil penalties in the amount of $1,250 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).
Licensee contacted LPA at approx 11:20 a.m. and stated they were unable to be onsite during the visit, but stated staff will sign in their place. 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: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 29-AS-20250716115150
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: 10/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/03/2025
Section Cited
CCR
87465(g)
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The licensee shall immediately telephone 9-1-1 if an injury or other circumstance... apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by:
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Licensee agreed to submit a written plan on how they will ensure residents will receive timely medical care and submit to CCL via email by COB 11/03/2025
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Based on interviews and records review, the licensee did not comply with the section cited above as, S1 did not attempt to call 911 or the Administrator after R1 had a fall, which posed an immediate health and safety risk to residents in care.
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Type A
11/03/2025
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 11/03/2025.
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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: 10/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 29-AS-20250716115150
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: 10/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/03/2025
Section Cited
CCR
87465(h)(2)
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Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
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Licensee agreed to review reg cited and submit a written plan to ensure future compliance and send to LPA via email by 11/03/2025.
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Based on observation the licensee did not comply with the section cited above as R1 had access to medication for all residents in care, which poses an immediate health, safety or personal rights risk to residents in care.
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Type B
11/07/2025
Section Cited
CCR
87468.2(a)(4)
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To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by:
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Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to CCL via email by COB 11/07/2025
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Based on interviews the licensee did not comply with the section cited above as R2 was left in a soiled diaper for extended periods and their foley Cather bag was not emptied in a timely manner which posed 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: 10/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 29-AS-20250716115150
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: 10/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2025
Section Cited
CCR
87303(a)
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The facility shall be clean, safe, sanitary and in good repair at all times.Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure facility is kept clean for future compliance then submit to CCL via email by COB 11/07/2025.
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Based on interviews and observations the licensee did not comply with the section cited above as bedrooms and common areas were not kept clean which posed a potential health, safety or personal rights risk to residents in care
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Type B
11/03/2025
Section Cited
CCR
87307(F)
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Basic laundry service (washing, drying, and ironing of personal clothing).
This requirement was not met as evidenced by:
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Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to CCL via email by COB 11/07/2025
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 Based on interviews the licensee did not comply with the section cited above as laundry services were not provided to residents in care in a timely manner, which posed 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: 10/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 29-AS-20250716115150
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: 10/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/03/2025
Section Cited
CCR
87555(b)(1)
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7
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 (15) hours shall elapse between the third and first meal. This requirement was not met as evidenced by:
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Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to CCL via email by COB 11/07/2025.
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Based on interviews and observations the licensee did not comply with the section cited above as nutrious meals, snacks and beverages were not provided to residents in a timely which posed a potential health, safety or personal rights risk to residents in care.
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Type B
11/03/2025
Section Cited
CCR
87625(b)(3)
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7
Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
This requirement was not met as evidenced by:
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Licensee agreed to review reg cited and submit a written plan to ensure future compliance and send to LPA via email by 11/07/2025
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Based on observation the licensee did not comply with the section cited above as R1 had access to medication for all residents in care, which poses an immediate health, safety or personal rights risk to residents in care
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9
10
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14
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: 10/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8