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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601684
Report Date: 07/17/2025
Date Signed: 09/27/2025 09:07:59 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.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
06/09/2025 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20250609124921
FACILITY NAME:VALLEY VILLAGE LARKSPUR HOUSEFACILITY NUMBER:
198601684
ADMINISTRATOR:KIMBERLY LOZANOFACILITY TYPE:
734
ADDRESS:15255 LARKSPUR STREETTELEPHONE:
(818) 587-9450
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:5CENSUS: 5DATE:
07/17/2025
UNANNOUNCEDTIME BEGAN:
11:09 AM
MET WITH:Alex Krasnoshtein - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Resident sustained unexplained injury while in care
INVESTIGATION FINDINGS:
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This is an amendment of report dated 07/17/25 to rectify typographical error.

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA initially met with staff Anthony Traba (LVN) who called back up Administrator Alex Krasnoshtein who arrived fifteen (15) minutes later. LPA explained the reason for the visit.

LPA conducted a physical plant tour at 11:10 AM, requested copies of facility documents relevant to the investigation at 11:33 AM, reviewed records between 11:35 AM to 12:35 AM and interviewed staff between 12:45 PM to 1:25 PM. Regarding the allegation that Resident sustained unexplained injury while in care, it was alleged that, during hospitalization for another medical condition, Resident #1 (R1) after further evaluation, was seen to have a hip fracture. LPA’s record review of R1’s hospital records today between 11:35 AM to 12:35 PM revealed that R1 has a right femoral neck fracture. (continued to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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 2
Control Number 31-AS-20250609124921
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: VALLEY VILLAGE LARKSPUR HOUSE
FACILITY NUMBER: 198601684
VISIT DATE: 07/17/2025
NARRATIVE
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(continued from LIC 9099)

Further review of X-Ray and Magnetic Resonance Imaging (MRI) results revealed that the fracture was chronic which basically means it did not happen recently. LPA’s interview with two (2) staff today revealed that there was no incident in the past one (1) year involving R1 that may have caused the fracture but R1 has medical condition that may have contributed to the fracture. Further record reviews also revealed that there was no incident report on record for the past one (1) year regarding R1 that could have caused any fracture.

Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2