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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610495
Report Date: 07/30/2025
Date Signed: 07/30/2025 02:31:54 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
02/28/2025 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20250228100858
FACILITY NAME:ROSSMOYNE HILLSFACILITY NUMBER:
197610495
ADMINISTRATOR:AVETISYAN, ARMINEFACILITY TYPE:
740
ADDRESS:1227 CAMPBELL STREETTELEPHONE:
(747) 338-8394
CITY:GLENDALESTATE: CAZIP CODE:
91207
CAPACITY:6CENSUS: 3DATE:
07/30/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Albert KhatchatryanTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Resident's medical records were not available at the facility
INVESTIGATION FINDINGS:
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At 1:45 p.m. on 07/30/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the licensee and disclosed the reason for the visit.

To investigate the allegations above, LPA Reed conducted an initial visit with LPA Huma Rahimi 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. of pertinent records, including but not limited to an admission agreement, medical assessment, and a care plan. The case was referred to the Investigations Branch (IB) on 02/28/25. The case was accepted by Investigator Olivia Spindola and Special Investigator Assistant (SIA) Amina Luckett on 03/04/25. Between 03/17/25 and 03/21/25, Luckett obtained a Glendale Fire Department Report, death and incident reports from the Glendale Polce Department Report, and medical records of Resident #1 (R1). From 04/02/25 to 06/12/25 Spindola interviewed residents and staff and obtained police bodycam footage and R1’s death certificate and autopsy report. LPA received and reviewed Investigator Spindola’s final report at 8:30 a.m. on 07/28/25.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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 4
Control Number 31-AS-20250228100858
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: 07/30/2025
NARRATIVE
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 Today, LPA toured the facility at 1:55 p.m.

Regarding the allegation "Resident's medical records were not available at the facility" it was alleged the facility did not maintain the records for R1. During an interview around 12:30 a.m. on 02/28/25 with County of Los Angeles Medical Examiner (CLAME) Investigator Jennifer Mantie, Administrator Armine Avetisyan stated that R1 arrived to the facility without any records. Avetisyan also confirmed this to LPA Reed during a telephonic interview at approximately 11:45 a.m. on 02/28/25. Avetisyan noted that she assessed R1 at their home prior to R1’s admission, but Avetisyan did not know where the assessment form was. When LPAs Reed and Rahimi requested R1’s records from Licensee Albert Khatchatryan, he provided records for four (04) of the six (06) residents in the facility. Khatchatryan did not provide records for R1. Based on observations, interviews, and record review, R1’s records were not available at the facility. Therefore, the allegation is deemed SUBSTANTIATED at this time. A deficiency is issued on the corresponding LIC 9099-D page.

No immediate health or safety concerns were observed during today’s visit.

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

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20250228100858
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: 07/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2025
Section Cited
CCR
87506(a)
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87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility.
This requirement was not met as evidenced by:
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Licensee to conduct and in-service training on the cited section with all staff and submit proof of training by the POC due date.
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Based on interviews, record review, and observations, the licensee did not comply with the section cited above by not maintaining compete records for at least three (03) residents whic posed a potential risk to the Health, Safety, or Personal Rights of 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: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4