197610479-7-20-2026-31-AS-NGID-DW8REZ-20260722125820

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610479
Report Date: 07/20/2026
Date Signed: 07/20/2026 09:32:37 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
10/20/2025 and conducted by Evaluator Perchui Khurshudyan

COMPLAINT CONTROL NUMBER: 31-AS-20251020195910

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:	07/20/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Nina Kharatyan - Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff left resident soiled for an extended period of time.
Staff does not ensure resident is turned resulting in resident sustaining a pressure injury.
Staff is wrongfully evicting resident.

INVESTIGATION FINDINGS:

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On 7/20/26, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan along with Gary Harutyunyan, SSMII, DASB Bureau Chief from CDSS / Community Care Licensing Division, conducted subsequent complaint visit to investigate the above allegation, and to deliver the final report. Upon arrival, LPA met with facility Administrator Nina Kharatyan and explained the reason for the visit.
During today's visit, LPA conducted physical plant tour to ensure health and safety of the residents are protected and the facility is in compliance with Title 22 Regulations. No health and safety hazards noted during the visit.
During the initial complaint visit conducted by LPA Khurshudyan on 10/29/2025, LPA requested copies of pertinent information, which include but are not limited to the copies of Clients’ files / documents, copies of staff training, copies of Incident Reports, copies of hospital/medical and Home Health agency reports, and other pertinent information relevant to the investigation. LPA also interviewed two (2) out of three (3) residents residing in the facility who were able to communicate and answer questions, Resident #2 (R2) and Resident #4 (R4), two (2) Caregivers, and the Administrator. Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

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-20251020195910

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: 07/20/2026

NARRATIVE

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LPA also reviewed the facility’s incident reports and interviewed the administrator regarding R1’s change in condition. The administrator stated R1 was transported to the hospital after staff observed a change in R1’s wound. However, based on interviews, record review, and documentation confirming that staff adhered to repositioning schedules and assisted R1 as needed, there is not sufficient evidence to prove neglect or lack of care by the facility. Therefore, the allegation is Unsubstantiated.

Allegation: Staff is wrongfully evicting resident.

LPA conducted a complaint investigation regarding the allegation that the facility wrongfully evicted R1. During the investigation, the Administrator was interviewed, and R1’s facility records, admission documents were reviewed. The Administrator stated that since R1’s admission, the facility had not received payment for services provided. Documentation showed an outstanding balance of $20,822.40, representing 99 days of care billed at a daily rate of $183.05. Despite the unpaid balance, the Administrator reported that the facility continued to provide R1 with the same care, supervision, and services offered to all other residents. According to the Administrator, R1 repeatedly stated he could not make payment because R1’s Supplemental Security Income (SSI) benefits were pending. The Administrator contacted the Social Security Administration, which confirmed R1’s SSI benefits were not pending and that R1 had been receiving monthly SSI payments. LPA reviewed financial documentation supporting the outstanding balance and found records consistent with the administrator’s statements. No evidence was obtained indicating R1 was treated differently from other residents or that the facility attempted to evict R1 for reasons other than non-payment for services provided. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the facility wrongfully evicted R1. Therefore, the allegation is Unsubstantiated at this time.

No Deficiency cited during today's visit.

Exit interview conducted and a copy of this report signed and delivered

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 31-AS-20251020195910

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: 07/20/2026

NARRATIVE

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Allegation: Staff left resident soiled for an extended period of time.

LPA interviewed the Administrator, staff, and residents able to communicate regarding the allegation. The Administrator denied the allegation and stated that residents are routinely monitored and assisted with toileting and incontinence care according to their individual needs. The administrator provided the facility’s incontinence care plan for review. LPA reviewed incontinence care logs and confirmed staff documented each care episode immediately after every brief change, demonstrating routine monitoring. Staff interviewed denied leaving any resident soiled for an extended period. Staff reported that R1 frequently requested assistance and often called caregivers every 15 to 20 minutes for various needs. Staff noted that R1 repeatedly requested a dedicated one-on-one caregiver and was informed multiple times that one-on-one care is not part of the facility’s standard services and would require private arrangements. Residents interviewed denied being left soiled for long periods and stated staff consistently assisted with personal care. During the visit, LPA observed caregivers conducting continuous rounds and checking on residents throughout the shift. Review of incontinence care documentation showed no evidence that residents were left soiled for extended periods. Based on interviews, observations, and record review, there is insufficient evidence to support the allegation that staff left R1 soiled for an extended period. Therefore, the allegation is Unsubstantiated at this time.

Allegation: Staff does not ensure resident is turned resulting in resident sustaining a pressure injury.

To investigate the allegation, LPA Khurshudyan interviewed the administrator, who reported that R1 was non-ambulatory but able to reposition himself/herself using his/her upper body. Although R1 did not require staff assistance for repositioning, staff frequently responded to his/her requests, often every 15 minutes, due to R1’s demanding nature. Interviews with residents able to communicate (R2 and R4) indicated that staff were attentive and routinely checked on residents. Resident R4, who is bedridden, stated staff repositioned him/her every two hours or sooner and that he/she rarely needed to request assistance. LPA reviewed the facility’s repositioning logs and confirmed documentation was completed properly by staff. Although R1 was receiving home health treatment for a pressure wound, records review revealed that facility staff assisted R1 with repositioning as R1 requested, and the documentation log confirmed this practice.

Continue LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

LIC9099 (FAS) - (06/04)

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