197609786-4-1-2025-29-AS-KHEN-DG6SAX-20250428134302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609786
Report Date: 04/01/2025
Date Signed: 04/01/2025 02:46:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
01/13/2025 and conducted by Evaluator Angela Barutyan

COMPLAINT CONTROL NUMBER: 29-AS-20250113104134

FACILITY NAME:	WOODLAND HILLS RETIREMENT HOME		FACILITY NUMBER:	197609786
ADMINISTRATOR:	KALISTRATOV, SERGUEI		FACILITY TYPE:	740
ADDRESS:	24301 OXNARD ST		TELEPHONE:	(818) 564-4381
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 4	DATE:	04/01/2025
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Irina Fried		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not provide a refund

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation at 01:55PM. Upon arrival, LPA met with staff and Administrator Assistant (AA) Irina Fried. Entrance interview conducted.

During today’s visit, LPA Barutyan conducted a brief physical plant tour and reviewed and obtained copies of pertinent documents. During the initial visit on 01/15/2025, LPA conducted a brief physical plant tour, conducted interviews with three (3) staff and discussed allegation with Licensee Serguei Kalistratov.

It was alleged that the facility did not provide a refund for pro-rated days after Resident #1 (R1) moved out of the facility. R1 voluntary moved out of the facility on 11/25/2024. Full monthly rent for November 2024 was paid 11/01/2024. CONTINUED ON LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250113104134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: WOODLAND HILLS RETIREMENT HOME	FACILITY NUMBER: 197609786
	VISIT DATE: 04/01/2025

NARRATIVE

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LPA reviewed R1’s signed admission agreement dated 08/14/2024. Per the admission agreement, “REFUND POLICY: Payment is made on the basis of the principle of ‘monthly payment.’ All charges for 'Basic Services' are due on the last day of each month. The Admission and Assessment fee is fully refundable.” The agreement does not specify facility refund policy concerning resident voluntary relocation or termination of the agreement for other reasons besides death of resident. The facility did not state in the signed agreement that pro-rated fees shall be refunded or that a move-out notice is required. Interviews with Licensee, AA, and R1’s responsible party confirmed that the facility agreed to refund the five (5) pro-rated days for November 2024 on 12/18/2024. During LPA’s initial visit on 01/15/2025, LPA observed the check refund held at the facility. The check was issued to R1 in the amount of $905.00 for five (5) days. Licensee stated that the check had not been mailed yet due to delays from the holiday season and the Pacific Palisades fires resulting in the facility’s evacuation. LPA reviewed communications between Licensee and R1’s responsible party which documented that multiple attempts for receiving/delivering the check refund were made from both parties between 12/18/2024-01/11/2025. LPA received and reviewed confirmation of the check mailed to R1’s responsible party via certified mail on 01/17/2025 and delivered on 01/21/2025. Based on record review, interview, and observation the information obtained during the investigation 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 “Facility staff did not provide a refund” is deemed UNSUBSTANTIATED at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025

LIC9099 (FAS) - (06/04)

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