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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610495
Report Date: 04/17/2025
Date Signed: 04/17/2025 02:46:37 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.ASC, 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
08/07/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240807095448
FACILITY NAME:ROSSMOYNE HILLSFACILITY NUMBER:
197610495
ADMINISTRATOR:AVETISYAN, ARMINEFACILITY TYPE:
740
ADDRESS:1227 CAMPBELL STREETTELEPHONE:
(747) 324-6116
CITY:GLENDALESTATE: CAZIP CODE:
91207
CAPACITY:6CENSUS: 0DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Elena KordonskiyTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff did not ensure catheter care was being provided to resident
Resident’s incontinence care was neglected in the facility
INVESTIGATION FINDINGS:
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At 1:00 p.m. on 04/17/2025 Licensing Program Analysts (LPAs) Nicholas Reed and Huma Rahimi conducted an unannounced complaint visit. LPA met with the new administrator, Elena Kordonskiy, and disclosed the reason for the visit.

To investigate the allegations above, LPA Duguma conducted an initial visit on 08/15/24 and requested documents at 02:15 PM and interviewed Staff #1 (S1) between 3:00 PM to 03:30 PM. During records request, S1 stated they cannot provide resident or staff documents as they do not have access. S1 then provided what documents they had for Resident #1 (R1) and stated they are no longer in the facility. R1 was not in the facility at the time of the visit. LPA Duguma returned on 10/30/24 but the visit was abruptly ended. LPAs Reed and Rahimi also conducted a subsequent visit on 02/28/25 and toured the facility at 10:15 a.m., interviewed residents and staff between 10:30 a.m. and 12:45 p.m., and conducted a record review at 1:00 p.m. Today, LPA requested R1’s records. No records were available for review. LPAs toured the facility at 1:45 p.m. The licensee and new administrator were present.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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-20240807095448
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 04/17/2025
NARRATIVE
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The administrator stated there are no other staff or residents currently. Due to the lack of records and eyewitnesses during this investigation, LPA Reed referenced pertinent interviews and record review of R1’s records from investigation of complaint # 31-AS-20240730093716 on 08/06/24.
Regarding the allegations "Staff did not ensure catheter care was being provided to resident" and “Resident’s incontinence care was neglected in the facility”, it was alleged that facility staff did not provide catheter care for R1 which led to their hospitalization on 08/07/24 for a urinary tract infection (UTI) with a foul odor. Interview with the former administrator at 9:35 a.m. on 08/06/24 revealed R1 was hospitalized on 07/26/24 for ‘excessive eating and drinking’. R1 returned with a catheter and home health services to assist with catheter care. The facility refused R1’s home health agency from entering the facility and instead used their own home health agency and in-house nurse. Follow up interview with the former administrator around 10:30 a.m. on 02/28/25 revealed the in-house nurse visited R1 once and said that the catheter only needed to be changed once per month. Therefore, no catheter care was provided. The former administrator also noted that the facility did not obtain refills of R1’s medications and did not assist with R1’s medications at the request of R1’s friend. Interview with S1 at 10:10 a.m. confirmed that the facility did not assist with R1’s medications for at least one month at the request of R1’s friend. Interview with R1’s friend at 11:00 a.m. on 08/06/24 revealed that they were not R1’s responsible party and were not on any of R1’s admission documents. R1’s friend noted that they told the former administrator to wait for all physician’s orders to arrive before assisting with medications and incontinence care. Interview with R1 at approximately 12:00 p.m. on 02/28/25 revealed they were never visited by a nurse or provided care for their catheter. When LPA visited the facility on 08/06/24, LPA observed R1 walking with their catheter bag in a dirty 5-gallon bucket. Record review of R1’s records on 08/06/24 at 10:30 a.m. revealed R1 had a history of UTI. No staff trainings were available regarding catheter care. No physician's orders for R1's catheter were present. Interview with the licensee at approximately 10:00 a.m. on 02/28/25 revealed they did not know where records were or if staff had any trainings. Six (06) out of six (06) residents interviewed on 02/28/25 had no pertinent information about R1. Based on observations, interviews, and record review, staff did not provide catheter care or incontinence care to R1 and had no training in catheter care. Home health also did not assist with R1's catheter care. Therefore, the allegations are deemed SUBSTANTIATED at this time. A deficiency is cited on the corresponding LIC 9099-D page.

Exit interview conducted. Appeal rights discussed. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20240807095448
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2025
Section Cited
CCR
87623(b)(1)
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87623 Indwelling Urinary Catheter
(b)... the licensee shall be responsible for the following: (1) Ensuring that insertion and irrigation of the catheter shall be performed by an appropriately skilled professional.
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The licensee has agreed to conduct an in-service training for themself and the adminsitrator on the cited section and submit proof of training by the POC due date.
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Based on interviews, observations, and record review, the licensee did not comply with the section cited above by not providing or arranging catheter care for Resident #1 (R1) leading to their UTI which posed an immediate Health, Safety, or Personal Rights violation to persons in care.
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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: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3