197610495-3-4-2025-31-AS-NRED-DEG3AH-20250304170447

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610495
Report Date: 02/28/2025
Date Signed: 03/04/2025 05:05:17 PM

Document Has Been Signed on 03/04/2025 05:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ROSSMOYNE HILLS		FACILITY NUMBER:	197610495
ADMINISTRATOR/ DIRECTOR:	AVETISYAN, ARMINE		FACILITY TYPE:	740
ADDRESS:	1227 CAMPBELL STREET		TELEPHONE:	(747) 338-8394
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91207
CAPACITY: 6		CENSUS: 6	DATE:	02/28/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	04:00 PM
MET WITH:	Albert Khatchatryan		TIME VISIT/ INSPECTION COMPLETED:	09:30 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

At 10:00 AM, Licensing Program Analysts (LPAs) Huma Rahimi and Nicholas Reed conducted an unannounced initial complaint visit. LPAs met with the Licensee Albert Khachatryan and contacted the Administrator via telephone and explained the reason for the visit.

LPAs toured the facility at 10:15 a.m. today, interviewed residents and staff between 10:30 a.m. and 12:45 p.m., and conducted a record review at 1:00 p.m.

Between 10:00 a.m. and 3:00 p.m. LPAs Nicholas Reed and Huma Rahimi noted the following deficiencies:

Upon entering at approximately 10:00 a.m., LPAs noted a strong, foul odor near the main entrance. LPAs could smell it from the dining room. Later, around noon, LPAs smelled the strong odor as well as a strong smell of urine. LPA Reed called the administrator at 11:45 a.m. The administrator noted a resident, Resident #7 (R7), passed away last night and the odor is likely from that.

During the facility tour, LPAs observed two (02) boxes blocking access to the immediate exit of Bedroom #2. Additionally, the door had an auditory alarm on it, but there was no handle, and the door was locked. LPAs reviewed the facility sketch in which this door was noted to be an emergency exit. Facility fire clearance was approved to retain 6 ambulatory residents. However, during licensing visits, LPAs observed a non-ambulatory wheelchair bound Resident #6 (R6) residing at the facility.

During the course of investigating complaint # 31-AS-20250220180232, the administrator also noted that they did not have a medical assessment for Resident #8 (R8) available for audit. The facility also did not have any records for Resident #5 (R5), R6, and R7. File were incomplete for Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), and Resident #4 (R4).

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROSSMOYNE HILLS	FACILITY NUMBER: 197610495
	VISIT DATE: 02/28/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Around 1:10 p.m. today, R4 came to the dining room and noted lunch had not yet been served and they had not received their medication. R3 and R6 also noted they had not received their blood pressure medication for a few days. When the licensee removed R4’s medication from the dining room refrigerator, LPAs observed that the medication was unlocked and accessible. Furthermore, the licensee and R4 did not know how to administer the medication, so R4 did not take their medication at that time. An officer from the Glendale Police Department arrived around 1:30 p.m. to investigate alleged elder abuse. When the officer interviewed the licensee at approximately 2:00 p.m. today, LPA heard the licensee tell the officer that although they were present last night when police came and the licensee was not aware of which residents were in the facility at the time. The licensee also stated that they were not the owner of the facility, Staff #1 (S1) did not work at the facility, and that they did not speak English well enough to answer any more questions.

LPA Reed called the administrator around 2:15 p.m. today and asked why Staff #2 (S2) was not associated to the facility, had no criminal background clearance, and had no file. The administrator stated S2 was in training for about two (02) weeks and had to be fired. LPA noted that S2 was observed by a credible source last night in the facility and stated they were the administrator.

At approximately 4:00 p.m. today, LPAs were notified by the administrator that the licensee had been arrested and all six (06) residents were left in the facility without care and supervision. The administrator noted the nighttime caregiver, Staff #3 (S3), was about an hour away from the facility.

Due to emergency circumstances, Licensing Program Manager Naira Margaryan along with Long Term Care Ombudsmans (LTCOs) Rachel Tate and Eriselda Herrera arrived to the facility between 5:00 p.m. and 5:30 p.m. at which time residents were left unattended and 4 police officers were present at the facility. LPM Margaryan and Police Officers made a phone contact to the Administrator Armine Avetisyan, and she refused to come to the facility due to personal health issues. No other staff arrived to the facility. One individual was observed outside of the facility. They refused to identify themselves. LPM and LTCO overheard the individual arguing with the police officers regarding the life camera(s) installed on the facility door. The individual left the facility after short while.

Due to time constraints, LPAs were unable to address all noted deficiencies and complete the report.

LPAs will revisit the facility at a future date to issue deficiencies as part of a case management visit.
No staff was present at the facility to sign this report.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC809 (FAS) - (06/04)

Page: 2 of 2