Facility Evaluation Report

Licensing Program Analysts (LPAs) Angela Barutyan and Quoc Huynh conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20260429152318). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation.

During the visit on 04/30/2026, LPAs observed Staff #1 (S1) and Staff #2 (S2) without a criminal record clearance transfer. Staff and Administrator Sargis Ayvazyan stated that S1 has been working at the facility for a few months and S2 started today on 04/30/2026.

Upon record review, LPAs observed that incident and death reports for Resident #1 (R1) were not submitted to the Woodland Hills North Regional Office. The Administrator stated that the incident report of R1’s hospitalization was submitted via email but was unable to provide proof. The Administrator additionally confirmed that R1’s death report was not submitted.

LPAs reviewed medications for R1 and observed R1’s centrally stored medication and destruction record (CSMDR) was not up to date. Medications did not have a physician’s order on file. Staff stated that the medications for R1 were destroyed, however, no written documentation could be provided. At 03:40PM, LPAs observed R1’s PRN Senna Tab 8.6mg at the facility. Staff #3 (S3) stated they kept the medication as they were using it for their stomach pain. Administrator destroyed the medication during the visit.

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Civil penalties were issued in the amount of $850 for criminal record clearance ($600) and repeat violation ($250) for CCR section 87465(e) ci ted on 07/02/2025 regarding physician’s orders to be maintained for medications. Failure to correct the deficiencies may result in additional civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.