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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610248
Report Date: 12/29/2025
Date Signed: 12/29/2025 10:39:26 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
10/31/2024 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20241031153253
FACILITY NAME:VELVET CAREFACILITY NUMBER:
197610248
ADMINISTRATOR:PAROYAN, NAIRAFACILITY TYPE:
740
ADDRESS:15731 LEMARSH ST.TELEPHONE:
(818) 810-0074
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 6DATE:
12/29/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cynthia Sherriel- DesigneeTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff neglect resulted in a resident sustaining multiple pressure injuries.
INVESTIGATION FINDINGS:
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This is an addendum to the original report issued 02/05/2025. Due to additional information received by the department, it was concluded that additional investigation is required.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent visit to this facility to deliver the corrected report to the facility. LPA met with facility administrator (S1) Naira Paroyan, who granted access to the facility.

On 10.31.2024, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding the allegation, “Staff neglect resulted in a resident sustaining multiple pressure injuries.” Initial investigation was conducted by the LPA Ngo-Castaneda on 11/01/2024. During the initial investigation, at 9:40AM, LPA requested copies of pertinent information which include, but not limited to Physician’s

Continue to LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
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 3
Control Number 31-AS-20241031153253
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VELVET CARE
FACILITY NUMBER: 197610248
VISIT DATE: 12/29/2025
NARRATIVE
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report, Admission Agreement, Staff Training, LIC 500, LIC 9020, hospice records, needs and service plan, discussion of hospice care plan, and relevant documents to the investigation. In addition, at 10:26 AM LPA spoke with the Administrator and other staff. At (time) LPA interview with five (05) out of six (06) residents.
On 11.5.2024, LPA requested R1’s medical records from the hospital. In addition, on 9.16.2025 LPA requested and received hospice records.

During this investigation R1 was no longer present at the facility. Other Residents interviewed during investigation did not address any concerns regarding their care at the facility. Staff interview revealed that staff assisted R1 with all activities of daily living. They stated that they were not assisting R1 with the wound care. Staff were relying on hospice nurses to provide assistance with wound care.

A review of hospice records revealed that between January 2023 and October 2024. on and off R1 developed unstageable, stage 3 and 4 pressure injuries Per hospice records on 10.07.2024 R1 had unstageable pressure injury on Sacro-Coccyx area and left (L) heel. Hospital records revealed R1 was admitted to the hospital on 10.28.2024, at which time R1 was presented with unstageable, Stage 3 and Stage 4 pressure injuries.

Based on inspection, observation, interviews and record review, facility admitted and retained a resident with prohibited health condition unstageable, Stage 3 and 4 pressure injurie, and staff at the facility failed to provide appropriate care and supervision to assist R1 with pressure injuries. Therefore, the allegation of "Staff neglect resulted in a resident sustaining multiple pressure injuries.” is deemed substantiated at this time.

The following deficiencies were issued and recorded on LIC9099-D.

Licensee was informed that an immediate Civil Penalty of $500.00 will be issued to the facility at the time of this visit. Additional civil penalty maybe be assessed at later time based on Health and Safety Code 1569.49.
Exit interview was conducted. Appeal rights discussed and a copy of report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20241031153253
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: VELVET CARE
FACILITY NUMBER: 197610248
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/30/2025
Section Cited
CCR
87615(a)
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Prohibited Health Conditions (a) Persons who require health services for or have health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not
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Within 24h the administrator will provide written plan of actions, explaining the steps the Licensee will take to ensure not admit/retain persons with prohibited health condition.
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 met as evidenced by; The licensee admitted and retained R1 with Unstageable, Stage 3, 4 Pressure injuries. This 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: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025
LIC9099 (FAS) - (06/04)
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