197610495-9-29-2025-31-AS-NMAN-DM7W4U-20251006165807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610495
Report Date: 09/26/2025
Date Signed: 09/29/2025 08:34:58 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.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 HILLS		FACILITY NUMBER:	197610495
ADMINISTRATOR:	AVETISYAN, ARMINE		FACILITY TYPE:	740
ADDRESS:	1227 CAMPBELL STREET		TELEPHONE:	(747) 338-8394
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91207
CAPACITY:	6	CENSUS: 0	DATE:	09/26/2025
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:			TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Neglect in care and supervision lead to resident's death

INVESTIGATION FINDINGS:

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At approximately 10:45 a.m. on 09/26/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced Licensing Visit to deliver findings for the above noted allegation. LPA was unable to meet with the lieensee or staff to disclose the reason for the visit.

It was alleged that on 02/27/25 at approximately 10:58pm, as Glendale Police Department (GPD) officers were present at the facility for a separate incident, one of the officers observed a resident #1 (R1) slumped over in their chair and appeared to be unresponsive. An officer checked R1’s pulse, realized that R1 had no pulse, and commenced with life saving measures. Glendale Fire Department was called by another officer. R1 was pronounced dead at the scene by Glendale Fire Department staff.

The investigation was initiated by the LPA Nicholas Reed on 02/28/2025. The allegation was referred to CCLD investigation Bureau and assigned to Senior Investigator (SI) Olivia Spindola.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

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-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: 09/26/2025

NARRATIVE

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During the investigation on 02/28/2025, LPA Nicholas Reed 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.
On 03/14/2025, SI Spindola reviewed records previously requested and obtained from Glendale Fire Department and GPD. In addition, SI Spindola reviewed medical records from the Kaiser Permanente Antelope Valley and Coroners Examiners Report. On 04/08/25, SI Spindola reviewed camera footage received from the GPD.

Interviews revealed that R1 was admitted to the facility over one (01) week prior, approximately on or after 1/14/25 with no records. The Administrator claimed she conducted a pre-assessment of R1, however, she could not produce any documentation. Staff #1 (S1) present at the facility revealed that they had no knowledge of R1’s health conditions, medication assistance and need and service plan. S1 stated that on the night of 02/27/25, Staff #2 (S2) gave R1 some yogurt about 30 minutes prior to the arrival of the police and R1 was responsive. R1 had no assigned bedroom and was staying in the living room. Glendale Police Records revealed that S1 informed the police that R1 was alive 30 minutes prior and was eating “yogurt and drinking water due to not being able to eat solid food.” S1, S2 and the Administrator informed GPD officers that they had no medical information for R1 and had no knowledge of R1’s medical issues. A review of Coroners Examiners Report and Kaiser records revealed that R1 had multiple health conditions that required medical attention that was not provided at the facility. Kaiser records revealed that R1 was admitted to the hospital on 01/06/2025 and was treated for several health conditions that required immediate medical attention. As of 01/14/2025, R1 was prescribed medication to control R1’s blood pressure, heart and kidney disease, and preventative heart medication. Review of police body camera footage on 02/27/25 at 10:54pm revealed R1 was seen slumping over a wheelchair by a living room window next to a fireplace. No staff were observed around R1. Based on inspection of the facility, review of medical records, and interviews, the facility admitted of R1 without any medical records or knowledge of their existing diagnoses, history of R1’s health conditions, or a list of R1’s medication, R1 was neglected and did not receive proper care and supervision which led to R1’s death. R1 passed away on 02/27/25. Therefore, the allegation of neglect in care and supervision lead to a resident’s death is SUBSTANTIATED. A $500 immediate civil penalty is assessed today for a violation resulting in injury and/or death to R1. The licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).

Appeal rights and copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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: 09/26/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/27/2025 Section Cited HSC 1569.312(e)	1 2 3 4 5 6 7	§1569.312 Basic services requirements Every facility... shall provide...: (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The facility is closed, and the Licensee is excluded from all Departmental involvement. No plan of correction possible at this time. Deficiency is therefore cleared.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not comply with the section cited above by not providing appropriate care and supervision to Resident #1 (R1) which posed an immediate Health, Safety, or Personal Rights risk to 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: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

LIC9099 (FAS) - (06/04)

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