197610976-6-18-2026-31-AS-TAGD-DVN2EC-20260703171944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610976
Report Date: 06/18/2026
Date Signed: 06/18/2026 01:35:36 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 Angelica Segovia

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20260604153733

FACILITY NAME:	AV ASSISTED LIVING		FACILITY NUMBER:	197610976
ADMINISTRATOR:	MIRZAKHANIAN, ARIGA		FACILITY TYPE:	740
ADDRESS:	10252 E AVE S		TELEPHONE:	(818) 469-2001
CITY:	LITTLEROCK	STATE: CA	ZIP CODE:	93543
CAPACITY:	20	CENSUS: 11	DATE:	06/18/2026
		UNANNOUNCED	TIME BEGAN:	01:11 PM
MET WITH:	Maria Espinioza- Caregiver		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Staff are not treating resident with dignity and respect.
Staff does not ensure resident receives adequate portions of food.

INVESTIGATION FINDINGS:

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On 6/18/2026 at approximately 1:10 PM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by staff and stated the reason for their visit was to deliver the findings of the complaint. The Licensee, Arlen Shahverdian was not available to assist with today’s visit and designated one of the care staff to sign today’s report. LPA provided the findings of the complaint to the Licensee.

To investigate the allegation(s), on 6/06/2026 at approximately 02:00 PM, LPA conducted a physical plant tour. By 02:30 PM, LPA requested relevant documentation. From 02:00 PM to 04:00 PM, LPA conducted interviews with eight (8) residents (R1-R8), three (3) staff members (S1-S3), and conducted record review.

(Continue LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

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-20260604153733

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: AV ASSISTED LIVING	FACILITY NUMBER: 197610976
	VISIT DATE: 06/18/2026

NARRATIVE

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Regarding the allegation: Staff are not treating resident with dignity and respect. It was alleged that staff do not treat R1 with dignity and respect. To investigate the allegation, LPA conducted interviews with eight (8) residents and three (3) staff members. LPA’s interview with R1 revealed that are not disrespected by staff but instead they hear staff speaking in Spanish complaining about helping residents. LPA’s interview with seven (7) residents confirmed staff treat them with dignity and respect. LPA’s interview with all three (3) staff members confirmed residents are not mistreated.

During LPA’s visit, LPA observed staff to be assisting residents with their Activities of Daily Living (ADLs) such as toileting, grooming and eating. LPA did not observe staff to be speaking to residents inappropriately. LPA did not observe staff to be disrespectful to residents. LPA observed staff to be speaking in Spanish (let it be noted LPA is fluent in Spanish) with one another and the residents who speak Spanish. LPA observed staff when speaking in Spanish were not speaking of any residents in a disrespectful manner.

Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff does not ensure resident receives adequate portions of food. It was alleged R1 does not receive adequate portions of food. To investigate the allegations, LPA conducted interviews with eight (8) residents and three (3) staff members. LPA’s interview with R1 revealed they witness staff giving other residents “bigger” portions of food than them. When LPA questioned, if they have any food restrictions/diet, R1 stated, “no”. when questioned if they were diabetic, R1 stated, "Yes”. LPA’s interview with seven (7) residents confirmed they are feed three (3) times a day and provided with snacks. LPA’s interview with all (3) staff members correlated with the seven (7) residents’ interviews. LPA’s interview with S3 revealed they have to monitor residents dietary restrictions for those who are diabetic or have food restrictions.

During LPA’s physical plant tour, LPA observed the kitchen to be supplied with sufficient seven (7) day nonperishable food and two (2) day perishable foods. Additionally, LPA observed residents’ dietary/food restrictions to be posted in the kitchen such as Diabetes data/food log, Basic Carb Counting, and High Potassium Foods.

(continue to LIC 9099-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20260604153733

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: AV ASSISTED LIVING	FACILITY NUMBER: 197610976
	VISIT DATE: 06/18/2026

NARRATIVE

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Furthermore, LPA observed S2 to be preparing food for residents. During LPA’s record review of R1’s physician’s report, the report confirmed R1’s diagnoses. LPA’s web search of said diagnosis revealed, “…portion control is key to managing blood sugar and weight”.

Based on interviews, record review and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the care staff..

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

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