197610479-7-16-2026-31-AS-MGFS-DW3V5U-20260717160831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610479
Report Date: 07/16/2026
Date Signed: 07/16/2026 10:15:51 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
04/10/2026 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:	0	CENSUS: 5	DATE:	07/16/2026
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Viktoriia Donska- Staff Designee		TIME COMPLETED:	10:45 AM

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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This report is a correct version of report dated 04/20/26 to cite correct deficiency and add additional information on the LIC9099.

On 04/20/26 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. On 4.13.2026, LPA attempted to contact facility’s consultant.

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: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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 3

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: 07/16/2026

NARRATIVE

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Allegation: Staff abandoned resident in an unlicensed facility.

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 on 3.19.2026 at 9:00PM was sent via medical transportation to another facility after S1 contacted their consultant. S1 communicated with the consultant they work with regarding R1’s need of higher level of care due to R1’s aggressive behavior towards staff and safety of other residents in the facility. S1 was not aware exactly where R1 was going. S1 did not communicate or disclose with R1's family where R1 will be going. Facility did not send an incident report to the department. S1 did not conduct a pre-placement appraisal for R1 before R1 left for another facility. Interview with S1 revealed that they just received the complete address of unlicensed facility where R1 was transferred to on 4.20.2026 at 11:00 AM in front of LPA. Proper placement did not meet the residents’ needs and S1 did not ensure facility was licensed for R1 to be transferred.

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

Second deficiency remains the same as noted in the report on 04/20/26. Third allegation remains unsubstantiated as noted on 04/20/26.

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: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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: 07/16/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/30/2026 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This was not met as evidence by:	1 2 3 4 5 6 7	A plan of correction was not created as the facility has been closed since 06/01/26.
	8 9 10 11 12 13 14	Based on interviews licensee did not ensure R1 was not abandoned in unlicensed care which poses an immediate risk to the health, safety, or personal rights of the persons 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: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC9099 (FAS) - (06/04)

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