197610479-4-20-2026-31-AS-MGFS-DW3V5V-20260717160831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610479
Report Date: 04/20/2026
Date Signed: 04/20/2026 03:39:37 PM

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
04/10/2026 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20260410140241

FACILITY NAME:	GOLDEN YEARS BOARDING CARE		FACILITY NUMBER:	197610479
ADMINISTRATOR:	KHARATYAN, NINA		FACILITY TYPE:	740
ADDRESS:	20358 KESWICK STREET		TELEPHONE:	(747) 226-0658
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 5	DATE:	04/20/2026
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	KHARATYAN, NINA- administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff abandoned resident in an unlicensed facility.

Staff did not communicate with responsible party regarding resident's changes.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced initial complaint visit to the facility to investigate the above allegation. LPA met with the facility administrator, Nina Kharatyan, and explained the reason for the visit.

To investigate the allegation, LPA toured the physical plant at 9:30 AM on 04.20.2026. LPA requested the facility staff roster (LIC 500), resident roster (LIC 9020), physician report, and other documents pertaining to the investigation. LPA reviewed documents at 11:46 AM, interviewed the administrator, staff, and five (5) residents who are at the facility from 10:20AM-11:45AM.

Allegation: Staff abandoned resident in an unlicensed facility.

Continue to LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

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 5

Control Number 31-AS-20260410140241

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: GOLDEN YEARS BOARDING CARE	FACILITY NUMBER: 197610479
	VISIT DATE: 04/20/2026

NARRATIVE

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It was alleged that the facility had abandoned a resident at an unlicensed facility. Interview with administrator (S1) revealed that resident #1 (R1) had been at the facility on 3.18.2026 at 6:00PM and left the facility on 3.19.2026 at 9:00PM. R1 was removed from the facility via medical transportation. R1 was remove from the facility due to needing a higher level of care, S1 was not aware exactly where R1 was going. S1 did not communicate or disclose with R1's family where they will be going. R1 did not receive any pre-placement appraisal before leaving for another facility. Interview with S1 revealed that they just received the complete address of where R1 was transferred to on 4.20.2026 at 11:00 AM in-front of LPA. Proper placement was not met the resident needs and S1 did not ensure facility was licensed for R1 to be transferred.

Based on information obtained from records review and interviews, the above allegation is deemed substantiated.

Allegation: Staff did not communicate with responsible party regarding resident's changes.

It was alleged that facility staff did not communicate with R1 responsible party regarding resident changes. An interview with residents revealed that they have no issue with facility staff communicating with their responsible party. Interview with S1 revealed that they have no information as to where R1 is going and let the referral agent communicate with R1 family.

Based on information obtained from records review and interviews, the above allegation is deemed substantiated.

Exit interview conducted, appeal rights discussed, and a copy of this report issued.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 31-AS-20260410140241

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: GOLDEN YEARS BOARDING CARE	FACILITY NUMBER: 197610479
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/20/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 05/04/2026 Section Cited CCR 87457(a)	1 2 3 4 5 6 7	Prior to acceptance of a resident, the licensee shall obtain and evaluate a written medical assessment of the prospective resident to ensure the facility can meet the resident’s needs. Based on interviews and record reviews the Licensee did not comply with the section	1 2 3 4 5 6 7	Licensee will ensure that Title 22 Regulations are followed for eviction procedures. Administrator will send statement that any resident that is evicted will be afforded the ability to go through the proper eviction process.
	8 9 10 11 12 13 14	cited above by failing to obtain proper pre-admission appraisal prior to R1s admission to the facility which posed a potential Health, Safety, or Personal Rights risk to persons in care.	8 9 10 11 12 13 14
Type B 05/04/2026 Section Cited CCR 87468.1(a)(8)	1 2 3 4 5 6 7	To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement is not met as evidenced by; Based on interview, facility did not meet with R1 family to	1 2 3 4 5 6 7	S1 will write a letter moving forward to notify all family/ responsible party regarding residents changes by POC date.
	8 9 10 11 12 13 14	discuss the details behind the most recent changes which poses a potential health safety and personal rights risk to residents in care	8 9 10 11 12 13 14

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: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
04/10/2026 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20260410140241

FACILITY NAME:	GOLDEN YEARS BOARDING CARE		FACILITY NUMBER:	197610479
ADMINISTRATOR:	KHARATYAN, NINA		FACILITY TYPE:	740
ADDRESS:	20358 KESWICK STREET		TELEPHONE:	(747) 226-0658
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 5	DATE:	04/20/2026
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	KHARATYAN, NINA- administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
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5
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7
8
9

Staff are not able to communicate with residents due to language barrier.

INVESTIGATION FINDINGS:

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2
3
4
5
6
7
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12
13

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced initial complaint visit to the facility to investigate the above allegation. LPA met with the facility administrator, Nina Kharatyan, and explained the reason for the visit.

To investigate the allegation on 04.20.2026, LPA took a tour of the physical plant at 9:30 AM. LPA requested the facility staff roster (LIC 500), resident roster (LIC 9020), physician report, and other documents pertaining to the investigation. LPA reviewed documents at 11:46 AM, interviewed the administrator, and interviewed (5) residents who are at the facility from 10:20AM-11:45AM.

Allegation: Staff are not able to communicate with residents due to language barrier.

Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 31-AS-20260410140241

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: GOLDEN YEARS BOARDING CARE	FACILITY NUMBER: 197610479
	VISIT DATE: 04/20/2026

NARRATIVE

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It was alleged that the facility staff was not able to communicate because of a language barrier. During this investigation on 4.20.2026, LPA spoke with the Administrator, staff, and residents. Staff were fluent in English. Caregivers may not be that fluent. However, they are able to communicate with residents. All interviewed residents during visits had no concerns about staff communicating with them. At the time of the visit, LPA spoke with staff and observed them communicating with residents in English. Interviews with residents all stated they can communicate with all staff, and staff are able to meet all their needs. During interviews with staff, LPA was able to communicate with them with no inconvenience.

Based on observation and interviews, there is no sufficient information to corroborate the allegation. Therefore, the allegation is unsubstantiated at this time.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 5