197610444-11-17-2025-31-AS-AJWR-DNX48G-20251130175243

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610444
Report Date: 11/17/2025
Date Signed: 11/17/2025 12:12:23 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.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
06/30/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250630142546

FACILITY NAME:	SUN VALLEY RESIDENTIAL CARE		FACILITY NUMBER:	197610444
ADMINISTRATOR:	VARDUHI AGHAJANYAN		FACILITY TYPE:	740
ADDRESS:	8667 HERRICK AVE		TELEPHONE:	(818) 404-0290
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY:	6	CENSUS: 1	DATE:	11/17/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Rebeka Durgaryan- Designee		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not prevent resident from becoming malnourished.
Staff did not prevent resident from becoming dehydrated.
Staff initiated hospice care services for resident without authorization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. At around 10:30 AM, LPA met with the administrator, Rebeka Durgaryan, and explained the reason for the visit.

During investigation, on 7.1.2025, LPA interviewed four (4) out of four (4) residents and a third-party from 9:28 AM to 11:30 AM. LPA requested and reviewed pertinent documents at 12:00 PM. The documents included but not limited too, staff roster, resident roster, physician report, admission agreement, appraisal needs and service plan, and other pertinent documentations.

Allegation #1: Staff did not prevent resident from becoming malnourished.

It was alleged that the facility was not providing adequate nutrition for the resident, which led to
Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025

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-20250630142546

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: SUN VALLEY RESIDENTIAL CARE	FACILITY NUMBER: 197610444
	VISIT DATE: 11/17/2025

NARRATIVE

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malnourishment. During LPA’s visit, it was observed that facility offers a well-balanced, nutritious, and edible meals throughout the day with various options. During interviews with staff, all staff stated they not only fed the residents and provided the same meals as everyone else but also purchased additional food according to R1’s preferences and dietary restrictions. During interviews with residents, all residents stated they are served three (03) meals a day and that snacks are available throughout the day. During an interview with a third-party, they stated that residents loved to eat and did not suspect any malnutrition or inconsistencies while visiting the facility. A review of the Physician’s Reports, admission agreement records, and hospital discharge documents did not indicate that the resident was malnourished.

Based on interviews, observations, and record review, there is not enough information to verify the allegation. Therefore, the allegation is Unsubstantiated at this time.

Allegation #2: Staff did not prevent resident from becoming dehydrated.

During LPA’s facility tour, it was observed that a cup of water with a straw is available beside the residents’ bedside table. Interviews conducted with the administrator and staff during the initial visit revealed that they always keep water next to the residents’ beds and that R1 was drinking fluids regularly. A review of medical records from the hospital did not reveal any information to verify that at the time of admission to the hospital, R1 was dehydrated.

Based on observation, interviews, and record reviews, this allegation is deemed Unsubstantiated at this time.

Allegation #3: Staff initiated hospice care services for resident without authorization.

It was alleged that Resident #1 (R1) was placed on hospice care without their authorization or knowledge. LPA phone interview with R1’s Power of Attorney (POA) at 3:00 PM on 7.1.2025 revealed that R1’s POA was aware of what they had signed and was advised on the services that hospice will provide.

Continue to LIC 9099-C

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20250630142546

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: SUN VALLEY RESIDENTIAL CARE	FACILITY NUMBER: 197610444
	VISIT DATE: 11/17/2025

NARRATIVE

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Staff Interview revealed that R1 was admitted to the facility on 5.15.2025. R1 was then approved for hospice coverage on 5.23.2025, due to their history of stroke and dementia. Therefore, R1's POA signed and agreed for R1 to receive hospice care. LPA reviewed of records revealed that hospice coverage of R1 was agreed and signed by resident’s health care POA. . Based on the interview information provided and record review, the allegation is deemed to be UNSUBSTANTIATED at this time.

No immediate health or safety hazards were observed during today’s visit.
Exit interview conducted, appeal rights and a copy of this report was provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2025

LIC9099 (FAS) - (06/04)

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