197610625-6-12-2026-31-AS-MGFS-DVUW5C-20260710165856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610625
Report Date: 06/12/2026
Date Signed: 06/12/2026 02:51:06 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
06/04/2026 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20260604164604

FACILITY NAME:	GUARDIAN ANGELS BOARD AND CARE		FACILITY NUMBER:	197610625
ADMINISTRATOR:	GOR KHURSHUDYAN		FACILITY TYPE:	740
ADDRESS:	11786 ENCINO AVE		TELEPHONE:	(818) 217-9444
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 4	DATE:	06/12/2026
		UNANNOUNCED	TIME BEGAN:	12:06 PM
MET WITH:	Tracy Mambwe		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff is abusing resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with staff, Tracy Mambwe, and advised her of the complaint. The administrator, Gor Khurshudya, was advised over the telephone. It was reported that Staff 1 (S1) has hit and thrown Resident 1 (R1) to the ground. There were no witnesses identified to this allegation, or date and time specified. Moreover, included to this report was that R1's physical exam at the hospital did not show evidence of significant assault, and R1 has made this claim before. Today's investigation consisted of interviews with the administrator and staff, held between 12:15pm to 12:45pm, interviews with four (4) residents, held between 12:45pm to 1:15pm, a physical plant inspection, held between 1:15pm to 2:00pm, and record review, held between 2:00pm to 2:30pm.

Regarding allegation: Staff is abusing resident, Interviews with the administrator and staff deny the allegation

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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-20260604164604

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: GUARDIAN ANGELS BOARD AND CARE	FACILITY NUMBER: 197610625
	VISIT DATE: 06/12/2026

NARRATIVE

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of abusing R1 or any of the facility residents. R1 has trouble adjusting socially, is impaired in decision making, and has made allegations similar to this in the past. R1 moved out of the facility voluntarily 06/01/26, and will not be returning. Administrator and staff does not know where R1 moved to. R1 only stayed at this facility for about one month. Interviews with four (4) of the four residents could not confirm the allegation. These residents expressed no complaints or concerns regarding care and supervision provided, adding their needs are met. Residents also deny that the administrator or staff has ever mistreated them, or been inappropriate towards them. Review of R1's records indicate some confusion and paranoia.

Based on the department’s observations, interviews which were conducted, and record reviews made, there was insufficient evidence to prove that staff is abusing residents. Therefore the above allegation is deemed Unsubstantiated at this time. Staff advised and a copy of this report issued.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC9099 (FAS) - (06/04)

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