197610966-3-17-2026-31-AS-MGFS-DT4T8B-20260413143004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610966
Report Date: 03/17/2026
Date Signed: 03/17/2026 05:03:42 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.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
03/12/2026 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20260312101942

FACILITY NAME:	BREATH OF SUNSHINE HARMONY		FACILITY NUMBER:	197610966
ADMINISTRATOR:	SIMONIAN, RUZANNA		FACILITY TYPE:	740
ADDRESS:	13644 KAGEL CANYON ST		TELEPHONE:	(323) 610-5587
CITY:	ARLETA	STATE: CA	ZIP CODE:	91331
CAPACITY:	6	CENSUS: 2	DATE:	03/17/2026
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Ruzzana Simonian - Administrator		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Staff unlawfully evicted a resident.
Staff is interfering with a resident's medical decisions.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Evelin Rios arrived to this facility to conduct and unannounced complaint visit. LPA was greeted by Staff # 1(S1) who contacted the licensee, Armen Simonian and administrator Ruzzana Simonian. LPA met with the Licensee and administrator shortly after and explained the reason for the visit. In the facility there were two (2) residents having breakfast and one (1) staff providing assistance.

The investigation consisted of the following: A physical plant tour was conducted to ensure the health and safety of residnets in care. LPA did not observe any health or safety concerns or issues. From 9:20 a.m. to 11:10 a.m., LPA attempted to interview two (2) out of two (2) residents, Resident #2(R2) and Resident #3 (R3). One (1) resident did not respond to LPA's questions and the other did not provide responses related to the complaint. LPA attempted to interview S1 but they preferred LPA direct questions to the administrator. LPA interviewed the administrator and the licensee. (Continue to LIC9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

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 6

Control Number 31-AS-20260312101942

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: BREATH OF SUNSHINE HARMONY	FACILITY NUMBER: 197610966
	VISIT DATE: 03/17/2026

NARRATIVE

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(Continued from LIC9099) LPA requested and obtained copies of the following documents: Register of Facility Residents (LIC 9020), Personnel Report (LIC 500), Resident #1's (R1's) admission agreement, Physician's Report (LIC602), Appraisal Needs and Services, Hospice documentation, 30 day eviction notice, and Unusual Incident Reports regarding R1. LPA Rios also interviewed R1's responsible party. LPA obtained copies of R1's after summary visit and wound consult from their time in the hospital.

The investigation revealed the following: Regarding the allegation: Staff unlawfully evicted a resident. It was alleged that R1 was not permitted to return to the facility after being cleared for discharge. Instead, the facility issued R1's responsible party a 30 day notice. LPA's review of the 30 day notice provided to R1's responsible party dated 3/11/2026 revealed it is not in compliance with Title 22, Division 6, Chapter 8, Article 4, Subsection 87224 Eviction Procedures. The eviction notice is missing information about resources available to assist in identifying alternative housing and care options, a statement informing residents of their right to file a complaint with the licensing agency, and the an exact statement as specified in Health and Safety Code Section 1569.683(a)(4). LPA's interview with the administrator revealed that the purpose of issuing the notice was to document the actions of R1’s responsible party related to the incident on 03/10/2026, and to inform the responsible party of the conditions that must be met before R1 could be readmitted so that facility may be in compliance with regulations. The facility may have provided a separate notice regrading their conditions for readmittance or conducted a re appraisal to update R1's care plan so that the facility may determine whether they would be able to meet R1's needs or not. Instead the facility provided a 30 day notice for breaking house rules.

Based on LPAs observations, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

(Continue to LIC9099-C) Page 2 of 3

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 6

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
03/12/2026 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20260312101942

FACILITY NAME:	BREATH OF SUNSHINE HARMONY		FACILITY NUMBER:	197610966
ADMINISTRATOR:	SIMONIAN, RUZANNA		FACILITY TYPE:	740
ADDRESS:	13644 KAGEL CANYON ST		TELEPHONE:	(323) 610-5587
CITY:	ARLETA	STATE: CA	ZIP CODE:	91331
CAPACITY:	6	CENSUS: 2	DATE:	03/17/2026
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Ruzzana Simonian - Administrator		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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9

Staff threatened a resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Evelin Rios arrived to this facility to conduct and unannounced complaint visit. LPA was greeted by Staff # 1(S1) who contacted the Licensee, Armen Simonian and Administrator Ruzzana Simonian. LPA met with the Licensee and Administrator shortly after and explained the reason for the visit. In the facility there were two (2) residents having breakfast and one (1) staff providing assistance.

The investigation consisted of the following: A physical plant tour was conducted to ensure the health and safety of clients in care. LPA did not observe any health or safety concerns or issues. From 9:20 a.m. to 11:10 a.m., LPA attempted to interview two (2) out of two (2) residents, Resident #2(R2) and Resident #3 (R3). One (1) resident did not respond to LPA's questions and the other did not provide responses related to the complaint. LPA attempted to interview S1 but they preferred LPA direct questions to the Administrator. LPA interviewed the Administrator and the Licensee. (Continue to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

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

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 31-AS-20260312101942

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: BREATH OF SUNSHINE HARMONY	FACILITY NUMBER: 197610966
	VISIT DATE: 03/17/2026

NARRATIVE

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(Continued from LIC9099) LPA requested and obtained copies of the following documents: Register of Facility Residents (LIC 9020), Personnel Report (LIC 500), Resident #1's (R1's) admission agreement, Physician's Report (LIC602), Appraisal Needs and Services, Hospice documentation, 30 day eviction notice, and Unusual Incident Reports regarding R1. LPA Rios also interviewed R1's responsible party. LPA obtained copies of R1's after summary visit and wound consult from their time in the hospital.

The investigation revealed the following: Regarding the allegation: Staff threatened a resident. It was alleged that R1 was not permitted to return to the facility unless they had Hospice services. LPA's review of an eviction notice provided to R1's responsible party provided conditions for re admittance to the facility without hospice. LPA's interview with R1's responsible party confirmed the administrator stated R1 could return to the facility with Home Health services but then received a 30 day notice which to them meant R1 was ultimately not allowed to return. LPA's interview with the administrator revealed that the purpose of issuing the notice was to document the actions of R1’s responsible party related to the incident on 03/10/2026, and to inform the responsible party of the conditions that must be met before R1 could be readmitted so that facility may be in compliance with regulations. The administrator stated family decided to transfer R1 out and picked up R1's belongings. LPA was unable to find corroborating evidence that the administrator would not have allowed R1 back without Hospice services.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted. Copy of report provided to the administrator.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 31-AS-20260312101942

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: BREATH OF SUNSHINE HARMONY	FACILITY NUMBER: 197610966
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/17/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/18/2026 Section Cited CCR 87224(d)(1)(B)-(D)	1 2 3 4 5 6 7	Eviction Procedures (d)(1)The notice to quit shall include the following information: (B) Resources available... (C)... their right to file a complaint with the licensing agency... (D) ...statement as specified in Health and Safety Code Section 1569.683(a)(4)...This requirement is not met by:	1 2 3 4 5 6 7	Licensee shall review eviction procedures and submit a statement of understanding to the department by POC due date 03/18/2026.
	8 9 10 11 12 13 14	Based on the observations, interviews and record reviews, the licensee did not ensure 30 day eviction was in compliance with Title 22, which poses in immediate Health, Safety or Personal Rights risks to person in care.	8 9 10 11 12 13 14
Type A 03/18/2026 Section Cited CCR 87468.1(a)(16)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services. This requirement is not met by:	1 2 3 4 5 6 7	Licensee shall review the subsections 87468.1 Personal Rights of Residents in All Facilities and 87633 Hospice Care of Terminally Ill Residents and provide a statement of understanding to the department by POC due date 03/18/2026.
	8 9 10 11 12 13 14	Based on the observations, interviews and record reviews, the licensee did not ensure R1's POA for Health Care was permitted to make medical decisions regarding R1’s hospice services which poses in immediate Health, Safety or Personal Rights risks to person in care.	8 9 10 11 12 13 14

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: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 31-AS-20260312101942

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: BREATH OF SUNSHINE HARMONY	FACILITY NUMBER: 197610966
	VISIT DATE: 03/17/2026

NARRATIVE

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Regarding the allegation: Staff is interfering with a resident's medical decisions. It was alleged that the facility would not allow R1’s responsible party to discharge R1 from hospice and would not provide a clear reason for R1’s hospice enrollment. LPA's interview with R1’s responsible party confirmed that they hold Power of Attorney for Health Care (POA), which LPA verified through documentation. According to the responsible party, when R1 was admitted, the administrator informed them that all residents admitted to the facility were on hospice. The responsible party acknowledged signing hospice paperwork but stated they were not provided copies when requested and were not given a clear explanation of R1’s hospice diagnosis. They reported that the administrator suggested R1’s wound might be the reason for hospice enrollment, which caused them to become concern. The responsible party further stated that they attempted to have R1 assessed by an outside physician due to concerns about the appropriateness of hospice services, but felt the facility discouraged this and insisted R1 remain on hospice. Which prompted them to contact emergency services to have R1's wound evaluated or taken to the hospital. R1's responsible party stated R1 is not terminally ill. LPA’s review of R1’s LIC 602 confirmed that R1 is not documented as receiving hospice services for a terminal illness. LPA's interview with the administrator revealed that the wound was identified at admission and that because a healthcare professional was required to oversee wound care they encourage R1's enrollment into hospice. The administrator acknowledged hospice enrollment would allow R1 to remain in the facility and the facility would be in compliance with Title 22, Division 6, Chapter 8, Article 11, Subsection 87633 Hospice Care of Terminally Ill Residents. The facility had the option to request a health condition exception or arrange for home health services to manage R1’s wound. Instead, the facility encouraged responsible party to enrolled R1 into hospice despite the absence of a terminal diagnosis and discouraged the responsible party from discontinuing hospice services so that R1 may remain in the facility.

Based on LPAs observations, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

An exit interview was conducted, California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D and a copy of this report was given to the administrator with the Appeal Rights.

Page 3 of 3

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 6