197610051-8-18-2026-29-AS-KHEN-DXDVDY-20260828162130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610051
Report Date: 08/18/2026
Date Signed: 08/18/2026 02:17:25 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
08/10/2026 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20260810121304

FACILITY NAME:	VALLEY VILLAGE SENIOR LIVING, INC.		FACILITY NUMBER:	197610051
ADMINISTRATOR:	AYVAZYAN, SARGIS		FACILITY TYPE:	740
ADDRESS:	5541 VANTAGE AVE.		TELEPHONE:	(818) 301-7551
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	6	CENSUS: 6	DATE:	08/18/2026
		UNANNOUNCED	TIME BEGAN:	10:19 AM
MET WITH:	Sargis Ayvazyan - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not providing activities for a resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted an initial complaint visit for the above allegation. The LPA arrived at 10:19AM and met with Administrator Sargis Ayvazyan. Entrance interview conducted.

Beginning at 10:27AM, the LPA and Staff toured the physical plant, and no immediate concerns were observed. Between 10:27AM and 11:37AM, the LPA interviewed three (3) residents, one (1) staff, and the Administrator. The following was then determined:

Allegation: “Staff are not providing activities for a resident in care”

It was reported that the facility was not providing residents with activities or exercise, and that residents only watch television (TV) throughout the day.

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026

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-20260810121304

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 VILLAGE SENIOR LIVING, INC.	FACILITY NUMBER: 197610051
	VISIT DATE: 08/18/2026

NARRATIVE

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During the physical plant tour, the LPA observed a whiteboard near the kitchen that stated “Excercise 11AM & 4PM.” In the entertainment center and cabinet near the whiteboard, the LPA observed a bingo set, jumbling tower (jenga), and dominos. The LPA additionally observed adolescent puzzles, crayons, and a coloring book in Bedroom #3. Throughout the visit, residents were observed resting in bed watching TV, and at approximately 11AM, three (3) residents were brought into the living room to utilize an electric foot massager, as part of the scheduled exercise activity.

Interview with staff indicated that the 11AM and 4PM exercise sessions consist of residents using an electric foot massager. Staff reported that they frequently accompany two (2) residents on walks in the neighborhood. Staff stated that the residents’ routine includes walking around the facility and the front yard, watching TV, and playing games. Staff further stated that three (3) residents participate in painting and games in the living room.

The Administrator reported that they are often present at the facility and observe staff and residents engaging in activities approximately “ninety-five percent (95%) of the time.” Activities include walking down the street, occasional outings to a nearby Starbucks, puzzles, crosswords, and similar activities.

Interview with three (3) residents confirmed that structured activities are not offered at the facility, and they denied participating in the scheduled 11AM and 4PM exercise sessions. Resident #1 (R1) reported that every other day staff took them on a short walk in the neighborhood and that they perform exercises independently in their room. R1 stated that they were content with watching TV and going on walks. Resident #2 (R2) stated that the staff come and go from their room but were unaware of any activities offered. Resident #3 (R3) reported spending their days watching TV, walking around the facility, and going outside to smoke. R3 expressed a desire to go on walks in the neighborhood and outings to the store but stated that staff do not take them.

Based on interview and observation, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur; therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026

LIC9099 (FAS) - (06/04)

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