197609969-5-7-2026-29-AS-KHEN-DUGS6K-20260527133603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609969
Report Date: 05/07/2026
Date Signed: 05/07/2026 05:29:33 PM

Substantiated

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
11/24/2025 and conducted by Evaluator Angela Barutyan

COMPLAINT CONTROL NUMBER: 29-AS-20251124120507

FACILITY NAME:	VALLEY VISTA SENIOR LIVING		FACILITY NUMBER:	197609969
ADMINISTRATOR:	ELIZABETH J WHITTINGTON		FACILITY TYPE:	740
ADDRESS:	7040 VAN NUYS BLVD		TELEPHONE:	(818) 906-4400
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	164	CENSUS: 127	DATE:	05/07/2026
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Stephanie Sarabia, Admissions Coordinator		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Staff did not ensure resident's care was increased following resident's surgery

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegations listed above at 11:40AM. LPA met with staff and Executive Director (ED) Maya Mnoyan. Reason for the visit was explained.

During today’s visit, LPA conducted a physical plant tour and obtained copies of pertinent documents. During the subsequent complaint visit on 04/28/2026, LPAs Barutyan and Q. Huynh interviewed five (5) staff and four (4) residents, conducted a physical plant tour, and obtained copies of pertinent documents. During the initial complaint visit on 12/03/2025, LPA Barutyan conducted interviews with three (3) staff members and two (2) residents, reviewed and obtained copies of pertinent documents relevant to the investigation, conducted a brief physical plant tour, and discussed allegations with former ED Aaron Mayes.

It was alleged that Resident #1 (R1)’s increased care needs were not being met following their scheduled surgery on 11/19/2025. Report Continued on LIC 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

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 7

Control Number 29-AS-20251124120507

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 VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 05/07/2026

NARRATIVE

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Prior to the surgery, R1 required minimal assistance with activities of daily living (ADLs), primarily with showering. However, following the surgery, R1 required significantly increased assistance with ADLs due to decreased mobility and drowsiness associated with newly prescribed medications. On 11/11/2025, R1’s responsible parties and former Executive Director (ED) Aaron Mayes held a care plan meeting to discuss R1’s anticipated increased care needs following the surgery. During the meeting, a temporary care plan was developed to address these changes. Interviews confirmed that notice of R1’s increased care needs was posted in the medication room for staff reference; however, no formal staff meeting or written notification was conducted to ensure staff were informed of the changes. During the initial visit on 12/03/2025, ED Mayes and staff confirmed that several staff members had not seen the notice posted in the medication room regarding R1’s change in care needs. Staff further stated that the required two-hour checks intended to begin following the surgery were not consistently implemented until staff became aware of the updated care instructions. LPA was unable to obtain R1’s service plan that was in effect prior to the surgery due to management and organizational changes at the facility. However, LPA obtained a service plan dated 12/03/2025. The service plan documented R1 as a Level 3 out of 5 care and indicated that R1 required assistance with toileting and incontinence care throughout the day and night (moderate assistance), no assistance with transferring, verbal reminders and cueing for mobility (minimal assistance), hands-on assistance with bathing (moderate assistance), support with dressing and selecting appropriate clothing (moderate assistance), and no assistance with grooming. Staff, R1, and R1’s responsible parties stated that prior to the surgery, R1 was able to independently perform all ADLs except showering. Following the surgery, R1 required frequent monitoring and assistance with all ADLs. Staff and ED Mayes acknowledged there had been a “miscommunication” regarding R1’s increased care needs. On 12/01/2025, ED Mayes conducted a mandatory meeting and in-service training for all medication technicians and caregivers on all shifts regarding staff responsibilities to ensure residents’ care needs were properly addressed. LPA also observed logs documenting that R1 received two-hour checks throughout the night on 12/01/2025 and 12/02/2025. The facility was unable to provide earlier logs due to the management change that occurred on 12/01/2025. Based on interview and record review, the allegation “Staff did not ensure resident's care was increased following resident's surgery” is deemed SUBSTANTIATED at this time. ED Mnoyan was unable to remain for the remainder of the visit and designated Admissions Coordinator Stephanie Sarabia to sign the report. Report was reviewed telephonically with the ED. The following deficiency was observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22. Administrator was informed that failure to correct the deficiency may result in civil penalties. Exit interview conducted. Appeal rights and a copy of the report provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 7

Control Number 29-AS-20251124120507

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 VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/07/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/14/2026 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	(f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident...with those activities of daily living such as dressing, eating, bathing... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	ED Mayes conducted a mandatory meeting and in-service training for all medication technicians and caregivers on 12/01/2025 regarding staff responsibilities to ensure residents’ care needs were properly addressed. ED Mnoyan stated that an in-service training will be conducted to review proper notification of care plan changes for residents. ED will submit proof to CCLD by the due date.
	8 9 10 11 12 13 14	Based on interview and record review, the licensee did not comply with the section cited as Resident #1 (R1)'s agreed upon increased need for assistance with activities of daily living following their surgery was not provided which posed a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 7

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
11/24/2025 and conducted by Evaluator Angela Barutyan

COMPLAINT CONTROL NUMBER: 29-AS-20251124120507

FACILITY NAME:	VALLEY VISTA SENIOR LIVING		FACILITY NUMBER:	197609969
ADMINISTRATOR:	ELIZABETH J WHITTINGTON		FACILITY TYPE:	740
ADDRESS:	7040 VAN NUYS BLVD		TELEPHONE:	(818) 906-4400
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	164	CENSUS: 127	DATE:	05/07/2026
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Stephanie Sarabia, Admissions Coordinator		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Staff did not ensure resident's clothes were changed
Staff did not change resident diapers/linens timely
Staff did not provide resident with necessary information to meet care needs

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

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 7

Control Number 29-AS-20251124120507

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 VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 05/07/2026

NARRATIVE

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It was alleged that Resident #1 (R1)’s clothes, briefs, and bedding were not changed in a timely manner. LPA interviewed R1, who stated that there had been occasions when their briefs were not changed promptly; however, R1 reported that they independently change their own clothing and that staff are responsible for changing the bedding. R1 was unable to recall specific details regarding any instance in which they remained in soiled briefs for an extended period of time. R1 stated that wet bedding is typically changed the same day and that bed linens are routinely changed weekly. R1 expressed no concerns regarding clothing changes and stated that they do not require assistance with dressing. LPA obtained R1’s service plan dated 12/03/2025, which documented R1 as a Level 3 out of 5 care and indicated that R1 receives assistance with toileting and incontinence care throughout the day and night (moderate assistance), support with dressing and selecting appropriate clothing (moderate assistance), and no assistance with grooming. Five (5) out of seven (7) staff interviewed stated that R1 frequently refuses care and services, particularly during the night and morning shifts, because R1 prefers to sleep in. R1 also confirmed that they do not like staff attempting to provide care or brief changes during the night or early morning hours. LPA reviewed logs from November and December 2025 documenting services provided to R1. The logs indicated that R1 did not receive a brief change during the AM shift for nine (9) out of twenty-five (25) days where R1 was at the facility from November-December 2025 due to being “unavailable.” ED Mayes stated that this is either due to R1 being asleep or R1 requesting staff to follow up at a later time. Staff interviews and statements from R1 confirmed that staff attempted to provide care during the morning hours, but R1 often preferred to continue sleeping. LPA also observed documentation reflecting that R1 received two (2) brief changes during the night (NOC) shift, which R1 confirmed. R1 stated that upon waking, they notify staff using their pendant when assistance or a brief change is needed. ED Mayes stated that although it may appear that R1 did not receive timely brief changes, the delays occurred because R1 was asleep and declined care at those times. Staff interviewed stated that multiple attempts to provide care were made and that responsible parties were notified regarding R1’s refusals. LPA interviewed five (5) additional residents, all of whom reported no concerns regarding incontinence care, bedding changes, or housekeeping services. Residents stated that linens are changed weekly or sooner if soiled and expressed satisfaction with housekeeping services. During a follow-up interview conducted on 04/28/2026, R1 confirmed that there was “never” a time when wet bedding was not changed. R1 also stated that they independently change their clothing daily. R1 further stated that staff did check on them, although response times occasionally “took a while.”

Report Continued on LIC9099-C.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 29-AS-20251124120507

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 VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 05/07/2026

NARRATIVE

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LPA also observed R1 and their room on 12/03/2025 and 04/28/2026 and observed R1 to be appropriately dressed and R1’s bedding to be dry. No immediate health and safety concerns were noted. Based on interviews, record review, and observation, the Department does not have sufficient evidence to corroborate the allegations. Although the allegations may be valid, at this time there is insufficient evidence to support the allegations or that a violation occurred, therefore, the allegations “Staff did not ensure resident's clothes were changed” and “Staff did not change resident diapers/linens timely” are deemed UNSUBSTANTIATED at this time.

It was further alleged that the facility did not provide R1 or their responsible parties with notice of required orders needed to provide care to R1. Staff interviewed stated that following R1’s toe amputation surgery on 11/19/2025, the surgical site was required to remain dry during showers. Staff reported that they protected R1’s foot by covering it with a plastic bag during showers in accordance with physician orders. LPA reviewed progress notes documenting that facility staff attempted to contact R1’s physician on 11/25/2025 to obtain clarification and an order regarding wrapping R1’s foot to allow showering. LPA also reviewed a physician’s order signed and dated 11/26/2025 stating that R1 was “allowed to have showers as long as [their] foot is dry. [R1] can use a plastic bag to cover [their] foot as [they] shower with tape as to prevent the dressings from getting wet.” Staff and R1 stated that R1 requested that a glove be placed over the surgical site instead of a plastic bag for extra security and waterproofing; however, the facility did not have a physician’s order authorizing the use of a glove. Staff stated that the post-surgical order specifically authorized the use of a plastic bag to cover the surgical site, and facility staff believed an additional physician’s order was required before using an alternative covering as the glove might be restrictive. Staff further stated that the facility notified R1 and R1’s responsible parties regarding the need for an updated physician’s order and attempted to contact R1’s physician to obtain clarification and authorization for the requested glove. In the meantime, staff continued covering R1’s foot with a plastic bag during showers in accordance with the existing physician’s order. R1 stated they had no concerns regarding shower assistance following the surgery and confirmed that showers continued to be provided. LPA reviewed R1’s service logs for November and December 2025, which documented that R1 received showers during the PM shift. The logs indicated that R1’s scheduled shower days were Monday, Thursday, and Saturday evenings.

Report Continued on LIC9099-C.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 29-AS-20251124120507

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 VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 05/07/2026

NARRATIVE

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Documentation further showed that R1 refused five (5) out of eleven (11) scheduled showers offered during the review period. R1 stated that showers were offered consistently and expressed no concerns regarding the shower services provided by staff. LPA also reviewed a physician’s order from R1’s supportive wound care provider, signed and dated 12/04/2025, stating: “Please keep bandage on both feet completely dry! When showering either put bag on or leave feet out.” Based on interview and record review, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation “Staff did not provide resident with necessary information to meet care needs” is deemed UNSUBSTANTIATED at this time.

ED Mnoyan was unable to remain for the remainder of the visit and designated Admissions Coordinator Stephanie Sarabia to sign the report. Report was reviewed telephonically with the ED.

Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

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