197609889-7-10-2025-31-AS-NMAN-DR7UWS-20260211145712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609889
Report Date: 07/10/2025
Date Signed: 07/10/2025 05:02:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/06/2025 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20250706210620

FACILITY NAME:	PEARL OF WEST HILLS, INC		FACILITY NUMBER:	197609889
ADMINISTRATOR:	IRINA, KARBACHINSKIY		FACILITY TYPE:	740
ADDRESS:	23427 VICTORY BLVD		TELEPHONE:	(818) 854-6306
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	6	CENSUS: 4	DATE:	07/10/2025
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Irina Karbachinskiy		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff hit a resident while in care
Staff denied a resident from food while in care

INVESTIGATION FINDINGS:

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At approximately 9:10 a.m. on 07/10/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA interviewed the administrator, two (02) residents, and a social worker between 9:15 a.m. and 11:45 a.m. today, conducted a record review of pertinent records, including but not limited to an admission agreement, care plan, and medical assessment, at 9:30 a.m., and toured the facility inside and out at 9:40 a.m.

Regarding the allegation "Staff hit a resident while in care" it was alleged the administrator slapped and karate chopped Resident #1 (R1). Interview with the administrator at 9:15 a.m. today revealed they never hit R1. The administrator noted R1 was having difficulty adjusting to the facility. Interview with R1’s roommate, Resident #2 (R2) revealed they never witnessed R1 get hit by anyone. R2 noted R1 panicked recently about something imaginary.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

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 31-AS-20250706210620

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PEARL OF WEST HILLS, INC	FACILITY NUMBER: 197609889
	VISIT DATE: 07/10/2025

NARRATIVE

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Interview with R1 at approximately 9:35 a.m. revealed they had never been hit by the administrator and enjoyed the facility. Interview with a social worker at R1’s day program at 11:30 a.m. revealed R1 had difficulty adjusting to the day program as well. The social worker also did not observe any marks or bruising on R1. Record review of R1’s file indicated some cognitive impairment but otherwise no pertinent information. LPA observed no bruising or marks on R1 during the interview. Based on observations and interviews, nobody indicated that the administrator had hit or hurt R1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff denied a resident from food while in care” it was alleged the administrator denied R1 a second portion of food when requested. Interview with the administrator revealed R1 was diabetic and often requested food s high in sugar when they saw other residents eating. The administrator noted they had to verbally redirect R1 from eating pastries and cakes as they may be harmful to their health. The administrator also confirmed they never denied R1 any food and offered healthier options instead. Interviews with R1 and R2 revealed that neither had been denied food and both were fed well and enjoyed the facility food. Record review revealed R1 was taking medication three (03) times daily for diabetes. LPA observed adequate supplies of perishable and non-perishable food in the home. Based on observations, interviews, and record review, the administrator offered R1 healthy alternatives but never denied R1 any food. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety hazards were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025

LIC9099 (FAS) - (06/04)

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