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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609869
Report Date: 04/22/2025
Date Signed: 04/23/2025 08:51:19 AM

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
08/21/2024 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20240821134235
FACILITY NAME:VALLEY VILLA SENIOR LIVINGFACILITY NUMBER:
197609869
ADMINISTRATOR:SIMITYAN, ARMENUIFACILITY TYPE:
740
ADDRESS:8315 SPARTON AVETELEPHONE:
(818) 994-5223
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 0DATE:
04/22/2025
UNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Armenui SimityanTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff leaves resident in bed for an extended period of time.
Staff does not attend to resident in a timely manner.
Staff does not provide adequate meal service to resident.
Staff does not administer medications as needed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced investigation visit at the facility regarding the allegations listed above. LPA arrived at the facility and the facility vacant at this time. The facility is going through renovations. No residents were at the facility on the day of the visit. One resident was relocated previous to the start of the renovation. The LPA communicated with the Administrator via the phone and read the report. The Administrator agreed to sign the report and return it to the LPA via email.

On 08/27/2024, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced 10-day complaint investigation visit at the facility regarding the allegations listed above. LPA Urena spoke with staff and informed of the visit. The staff contacted the Administrator Armenui Simityan at 11:15 a.m. to inform them of the visit. The LPA spoke with the Administrator on the phone and explained the reason for the visit. LPA Urena conducted staff and residents' interviews from 11:19 a.m. to 1:22 p.m. The LPA reviewed records pertinent to the investigation from 1:25 p.m to 1:40 p.m. . Continues on LIC 9099C...

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
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 6
Control Number 29-AS-20240821134235
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: VALLEY VILLA SENIOR LIVING
FACILITY NUMBER: 197609869
VISIT DATE: 04/22/2025
NARRATIVE
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Staff leaves resident in bed for an extended period of time.
On the allegation that staff leaves resident in bed for extended periods of time, it is the concern of the reporting party (RP) that the staff do not assist residents to get up from the bed. Residents are kept in bed all the time except when residents receive physical therapy (PT) twice a week. To investigate the allegation, the LPA interviewed residents, and the interviews revealed that the facility has only one staff; consequently, the staff does not assist residents in getting up from bed. The LPA interviewed the staff (S1), and the staff stated that they can only assist residents with repositioning and transferring from bed to wheelchair, residents receive PT twice a week and assist residents with mobility. Record review revealed that residents in care are receiving PT twice a week for mobility.
Based on the interviews and record review, although the allegation may have happened or is valid, based on the interviews, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Staff does not attend to resident in a timely manner.
On the allegation that staff do not attend to residents in a timely manner, the concern of the RP that the facility staff do not attend to the residents when they call for help, and when the residents ask for something, the staff take a long time or ignores the request. The residents’ interviews revealed that one resident stated that when they ask for a condiment for food the staff often ignore their call and requests, or takes a long time (45 minutes to provide the condiment). The staff’s interview revealed that they do attend to the requests of the residents and denied ignoring the residents’ calls for help.
Based on the information obtained through interviews, although the allegation may have happened or is valid, based on the interviews, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Continues on LIC 9099 C... page 3.


SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20240821134235
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: VALLEY VILLA SENIOR LIVING
FACILITY NUMBER: 197609869
VISIT DATE: 04/22/2025
NARRATIVE
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Pg. 3.
Staff does not provide adequate meal service to resident.
On the allegation that staff does not provide adequate meal service, it is the concern of the RP that the staff only serves the same meals over and over, sometimes sandwiches for dinner or a bagel and sometimes macaroni. Residents’ interviews revealed that if they fall asleep during one of the three meals the staff won’t wake them up, and alleged that they did not get to eat because they fell asleep. One resident stated that the meals are ‘ok’. The staff only provides three meals, cold cereal in the mornings, and no snacks unless the residents ask for a snack. LPA Urena conducted a physical plant tour of the kitchen, and the facility appeared to have sufficient and a variety of foods for the residents in care. The staff’s interview revealed that they prepare three meals a day for the residents in care, which include vegetables, meat and fruit. Breakfast includes oatmeal, cereal, and drink. Staff stated that they provide snacks, but only if the residents request a snack. The snack typically consists of cookies.

Although the allegation may have happened or is valid, based on the interviews, and observation, the staff provided at least three meals during the day, and a snack when requested by residents in care. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff does not administer medications as needed.
On the allegation that staff does not administer medications as needed, it is the concern of the RP that the OTC pain medication is sometimes not given when asked for. To investigate the allegation the LPA conducted medication audit, and interviewed residents in care. The medication was properly documented in the Centrally Stored Medication and Destruction Record form (LIC622). The residents interview revealed that sometimes they will ask for the over-the-counter pain medication and the staff will not provide as requested. One resident stated that they get their prescribed medications on time.

Although the allegation may have happened or is valid, based on the interviews, and observation, the staff provided prescribed medications as prescribed by the physician. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview was conducted. Copies of the report were issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
08/21/2024 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20240821134235

FACILITY NAME:VALLEY VILLA SENIOR LIVINGFACILITY NUMBER:
197609869
ADMINISTRATOR:SIMITYAN, ARMENUIFACILITY TYPE:
740
ADDRESS:8315 SPARTON AVETELEPHONE:
(818) 994-5223
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:6CENSUS: 0DATE:
04/22/2025
UNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Armenui SimityanTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff does not ensure resident's grooming needs are met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced investigation visit at the facility regarding the allegations listed above. LPA arrived at the facility and the facility is going through renovations. No residents were at the facility on the day of the visit. One resident was relocated previous to the start of the renovation. The LPA communicated with the Administrator via the phone and read the report. The Administrator agreed to sign the report and return it to the LPA via email.

On 08/27/2024, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced 10-day complaint investigation visit at the facility regarding the allegations listed above. LPA Urena spoke with staff and informed of the visit. The staff contacted the Administrator Armenui Simityan at 11:15 a.m. to inform them of the visit. The LPA spoke with the Administrator on the phone and explained the reason for the visit. LPA Urena conducted staff and residents' interviews from 11:19 a.m. to 1:22 p.m. The LPA reviewed records pertinent to the investigation from 1:25 p.m. to 1:40 p.m.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20240821134235
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: VALLEY VILLA SENIOR LIVING
FACILITY NUMBER: 197609869
VISIT DATE: 04/22/2025
NARRATIVE
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Staff does not ensure resident's grooming needs are met.
On the allegation that staff does not ensure resident’s grooming needs are met, it is the allegation of the RP that they had observed residents’ hair being hair knotted and tangled from not being brushed, and residents’ diapers are not being changed frequently enough. Residents’ interviews revealed that they get a diaper change only twice a day, and not at night. They must sleep on their wet/soiled diaper throughout the night. The staff’s interview revealed that they change diapers twice a day and when the residents request at night.

Based on the information obtained through interviews, the staff is not following regulations based on the staff’s answer on how many times the staff attend to the residents’ needs for a change in diaper. Therefore, the allegation is deemed Substantiated at this time.

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

Citations were issued. Exit interview was conducted. A copy of the report and Appeal rights were issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20240821134235
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: VALLEY VILLA SENIOR LIVING
FACILITY NUMBER: 197609869
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/22/2025
Section Cited
CCR
87625(b)(2)
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87625(b)(2) Managed Incontinence. …The licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by:
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The Administrator agreed to do the following: 1. Ensure that the new staff will follow regulations and will check and change the residents needs every two hours. The Administrator stated that the facility will be hiring all new staff, and will be trained according to the regulations.
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Based on interviews, the licensee did not comply with the section cited above, as R1 and R2 were not check periodically and at night, 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: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6