197610444-2-5-2026-31-AS-NMAN-DSD24T-20260320170428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610444
Report Date: 02/05/2026
Date Signed: 02/05/2026 09:49:45 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
04/15/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250415121049

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:	02/05/2026
		UNANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Rebeka Durgaryan- Licensee		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Resident developed pressure injuries in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Leslie Ngo-Castaneda conducted a subsequent complaint visit to the facility to investigate the above allegation. LPA met with the licensee, Rebeka Durgaryan, and advised them about the visit.

An entrance interview was conducted.

To investigate the allegation on 11.17.2025 at 10:00 AM, LPA conducted a physical plant tour to ensure the health and safety of the clients in care. LPA interviewed one (1) out of one (01) residents and three (3) staff (including the licensee) from 11:53 AM- 12:20 PM, LPA received and reviewed copies of documents related to the investigation, including the staff and resident roster, resident #1 (R1) physician report, identification and emergency information, Appraisal needs and service plan, medication

Continue to LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026

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 31-AS-20250415121049

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: 02/05/2026

NARRATIVE

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administration records and other relevant documents. Prior to this visit on (date) LPA reviewed R1’s medical records previously requested from the hospital.

Allegation: Resident developed pressure injuries while in care.

It was alleged that R1 developed pressure injuries while in facility care. Interviews with one (1) resident revealed they had no issues with pressure injuries. Interview with S1 stated that R1 is not on hospice or receiving home health services to get assistance for their pressure injuries. Facility staff are the ones assisting in changing the bandages and cleaning the wound. According to S1, they do not position or rotate R1. R1 is wheelchair bound resident and uses their heels to push and maneuver themselves around the facility using their wheelchair.

A review of R1’s medical assessment revealed they had no history or signs of skin breakdown as of 3.15.2025. On 04.14.25 R1 was admitted to the hospital for pressure injuries. Upon admission to the hospital, R1 had pressure injuries (PI) on their bilateral heel. The left (L) heel PI is unstageable, measuring 6x8.5cm. The right (R) heel is a Deep Tissue Pressure Injury (DTPI), measuring 2.5 x 3.5 cm.

Information received revealed that R1 developed health conditions requiring higher level of medical care (unstageable and dip tissue pressure injuries). R1 was not receiving home health or hospice care services, and the wound care was provided by facility staff, that were not skilled professionals.

Based on interview and record review it was concluded that R1 developed prohibited health condition and facility did not sought appropriate medical care. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on the LIC 9099-D page.

Exit interview conducted. Appeal rights discussed. Copy of this report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250415121049

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/05/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/06/2026 Section Cited CCR 87615(A)(1)	1 2 3 4 5 6 7	Prohibited Health Conditions Persons who require health services for or have a health condition, including, but not limited to, those specified below, shall not be admitted or retained in RCFE...: (1) Stage 3 and 4 pressure injuries. This	1 2 3 4 5 6 7	Licensee will provide written plan of action explaining the steps facility will take to ensued that moving forward similar issues will not happen. The Licensee will conduct in-service training for the Administrator and other staff regarding cited section and submit proof by the POC due date.
	8 9 10 11 12 13 14	requirement was not met as evidenced by: Based on interviews and record reviews, the licensee do not comply with the section cited above by retaining R1, who developed unstageable pressure injuries while under the facility care, which posed an immediate health and safety risk to the resident 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: Naira Margaryan
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026

LIC9099 (FAS) - (06/04)

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