Victoria's Dignity Care

Type of visit: Case Management - Licensee Initiated

At 11:30 a.m. on 07/23/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with the administrator and disclosed the reason for the visit. Today’s case management visit was conducted due to an email received by the Woodland Hills-South Adult and Senior Care Office on 06/29/25 from the licensee informing the Department that the licensee wished to close the facility and surrender the license. It was reported on 07/14/25 during an office meeting that all residents had relocated from the facility and the census was zero. LPA toured the facility today at approximately 12:10 p.m. and confirmed that no residents or resident belongings were in the facility. LPA removed the physical license. No immediate health or safety concerns were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: Office

At 11:00 a.m. on 07/14/25 Regional Manager (RM) Angela Whittaker, Licensing Program Manager (LPM) Naira Margaryan, Licensing Program Analyst (LPA) Nicholas Reed, and Administrator Anahit Manukyan met at the Woodland Hills-South Regional Office for an announced Informal Meeting. Licensee Ara Akopyan joined via telephone as well. The purpose of today’s meeting was to discuss the current status of the facility license, the intentions of the licensee to close the facility, and the current welfare of the residents. Interview with the administrator at 11:05 a.m. and with the licensee’s family member at 11:10 a.m. confirmed that the licensee wants to surrender the license. Both parties noted that all residents were removed from the facility as of yesterday, 07/13/25. The administrator noted they already tried to apply for a new license approximately one (01) year ago without resolution. The administrator inquired on the best way to apply for a new license for the address so the residents may return. RM and LPM noted the Department will review the administrator’s initial application with the Centralized Applications Bureau and provide guidance towards reapplying. LPA and Administrator discussed the current welfares and whereabouts of the five (05) residents. LPA will continue case management visits to the facility and resident locations to ensure compliance with Title 22 regulations. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 14, 2025

Type of visit: Case Management - Other

At 9:30 a.m. on 06/19/25, Licensing Program Manager (LPM) Naira Margaryan and Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. Today’s case management visit was conducted to ensure the health and safety of facility residents and the facility’s compliance to Title 22 Regulations. LPM and LPA interviewed staff and residents between 9:40 a.m. and 11:30 a.m. today, conducted a record review of pertinent records, including but not limited to an admission agreement, medical assessment, care plan, and staff and client rosters at 9:45 a.m., and toured the facility inside and out at 11:15 a.m. Interview with Staff #1 (S1) at approximately 10:45 a.m. revealed that Staff #2 (S2) was a live-in staff. S1 further noted that Resident #1 (R1) was recently admitted. The facility moved Resident #2 (R2) into the staff room when R1 was admitted. Facility tour revealed two beds were set up in the staff room. Record review revealed R1 was admitted to the facility on 06/06/25. A deficiency is issued for a resident sleeping in the staff room. During the facility tour, LPA observed Resident #3 (R3) was residing in Bedroom #2. Record review of R3’s medical assessment revealed they are bedridden. File review of the facility’s fire clearance at 11:15 a.m. today revealed Bedroom #3 was designated for a bedridden resident. Interview with S1 revealed R3 has been residing in Bedroom #2 for over two (02) years. A deficiency is issued for violating the facility’s fire clearance by placing a bedridden resident in a non-ambulatory room which was not designated for bedridden residents. Other deficiencies were discovered during this visit which will be cited at a later date. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Jun 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a) · Plan of correction due date: Jun 20, 2025

87307 Personal Accommodations and Services (a) Living accommodations... shall be related to the facility's function. The facility shall... provide comfortable living accommodations and privacy for the residents, staff, and others... This requirement was not met as evidenced by: Based on interviews, record review, and observations, the licensee did not comply with the section cited above by placing a resident in the staff room which posed an immediate risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jun 19, 2025

Plan of correction: Within 24 hours, the administrator designee will provide written statement explaining the plan to correct the deficiency. LPA advised that the plan must be measurable and verificable with photographic evidence of correction.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.72(c) · Plan of correction due date: Jun 20, 2025

§1569.72 Residents requiring skilled nursing or intermediate care; bedridden residents (c) Notwithstanding... bedridden persons may be admitted to, and remain in, residential care facilities for the elderly that secure and maintain an appropriate fire clearance. This requirement was not met as evidenced by: Based on interviews, record review, and observations, the licensee did not comply with the section cited above by placing a bedridden resident in a room which was not cleared for a bedridden resident which posed an immediate risk to the Health, Safety, or Personal Rights of persons in care.the state’s words, verbatim · CDSS document, Jun 19, 2025

Plan of correction: Administrator to request resident and representative permissions and switch residents in Bedroom #2 with residents in Bedroom #3. LPA advised that information must be measurable and verificable with photographic evidence of correction.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Tatayana Hakobyan for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 3:20 PM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of four (04) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory. The facility is currently occupying five (05) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 76°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen, observed to be fully charged. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 112.1°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 27, 2024

Type of visit: Required - 1 Year

On 12/26/2023 at 09:29 AM, Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – Annual Continuation Inspection and met with Administrator Jack Berghoudian. Five (5) residents and three (3) staff were present during this inspection. Facility is licensed to serve four (4) non-ambulatory residents, one (1) may be bedridden in any room. The facility also has an approved hospice waiver for six (6) residents. The facility currently has 4 non-ambulatory residents. Hospice waiver for 4 residents. Age range of residents 60 and over. The Annual Licensing Fees are current. Facility has four (4) four bedrooms: (3) three shared bedrooms for clients and (1) bedroom designated as employee room. There are two (2) bathrooms: (1) one for clients located in hallway near client’s bedrooms #1 and #2. There is no body water in the facility. LPA conducted a tour of the physical plant at 9:40 am to ensure there are no health and safety hazards and facility staff are following Title 22 Regulations and the following was noted. S1 and S3 accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured, there are (3) three covered patio sections: (2) two for clients use and (1) for staff use. All observed to be clean and furnished with adequate seating, and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 109F-110F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with covers. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 109F-110F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with covers. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit and manual was located near the administrator desk.Three (3) fire extinguishers in the facility: one (1) in foyer/waiting room, one (1) in the living room and one (1) in the kitchen. Extinguishers were observed to be charged with receipt dated June 12th, 2023. Dual Smoke alarms and carbon monoxide are hardwired and interconnected, were tested and observed to be operable. Medications are located in the kitchen locked in separate wood file cabinet. A locked mini fridge situated on top of medication file cabinet holds prescription eye drops and diabetes medication. Medication was observed to be inaccessible to clients. The first aid kit located in foyer near administrator workstation observed to be fully stocked. At 10:40AM LPA conducted a facility file review. 5 staff records were reviewed, 5 out of 5 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. 5 resident records were reviewed and, 5 out of 5 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. No deficiencies cited. An exit interview was conducted. A copy of this report and appeal rights were left with Administrator Jack Berghoudian.the state’s words, verbatim · CDSS document, Dec 27, 2023

Allegation investigated: Residents were signed up for hospice services without their knowledge. Residents were signed up for hospice services without a physician's referral.

At 8 :00 a.m. on 12/20/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with Staff #1 (S1) and later the administrator at approximately 8:30 a.m. and disclosed the reason for the visit. Regarding the allegation “Residents were signed up for hospice services without their knowledge” it was alleged that the hospice consent forms of Resident #1 (R1) and Resident #2 (R2) were signed by facility staff S1 and Staff #2 (S2). To investigate the allegation, LPA reviewed pertinent records including but not limited to physician reports, preplacement appraisals, appraisals, needs and service plans, identification forms, Physician Orders for Life Sustaining Treatment (POLST) forms, hospice care plans, and hospice consent forms at 8:15 a.m., interviewed administrator and staff between 9:10 a.m. and 11:30 a.m., interviewed R1 at 10:00 a.m. and R2 at approximately 10:30 a.m., toured the facility at 10:00 a.m., and interviewed family members between 12:15 a.m. and 1:00 p.m. Substantiated Interview with the administrator revealed that R1’s family was not able to visit the facility to sign the hospice consent forms in person, so R1’s family authorized S1 to sign the form. Interview with S1 confirmed they had signed R1’s hospice form. S1 stated S2 did not sign any resident forms. Interview with S2 revealed they had not signed any resident forms. Interview with R1’s family revealed they did authorize the facility staff to sign R1’s hospice form. Interview with R2 revealed they did not recall whether they signed paperwork. Record review of R1 and R2’s revealed their hospice care plans were signed by a registered nurse, a medical social worker, a spiritual counselor, and a medical director, but were not signed by the licensee, R1, R2, or their responsible parties. Additionally, records detailing facility personnel duties, hospice visits, personnel trainings, and roommate acknowledgements were not maintained or available. These deficiencies are addressed on a separate LIC 809 – Case Management visit. R1’s hospice consent form was signed on 07/12/2022. The signature does not match R1’s signature. The box “Beneficiary is unable to sign” is checked. Hospice consent forms of R2 appeared to be signed by R2. R1’s POLST from 09/30/2020 and R2’s POLST from 06/16/2020 appeared to be signed by R1 and R2 as well. Based on interviews and record reviews, S1 signed R1’s hospice consent form. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency cited on the attached LIC 9099-D page. Regarding the allegation “Residents were signed up for hospice services without a physician's referral.” it was alleged R1 and R2 were enrolled in hospice services without a physician’s referral. Interview with the administrator revealed the facility was unable to arrange R1’s doctor’s appointment to obtain a referral. The administrator knew R1 had previously been enrolled in hospice, therefore the facility proceeded in assisting R1 in signing up for hospice services without the referral. Records revealed that R1 was previously enrolled in hospice services as of 10/14/2020. R1’s most recent hospice care plan indicated services began on 07/07/2023. R1’s most recent medical assessment on 08/18/2023 noted R1 was not enrolled in hospice services, and R1’s family signed forms discharging R1 from hospice on the same day. R2’s most recent medical assessment on 08/02/2023 noted R2 was enrolled in hospice services. Based on interview and record review, R1 did not have a physician’s referral for hospice services. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency cited on the attached LIC 9099-D page. No immediate health or safety hazards were observed during today’s visit. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Dec 20, 2023 · control 31-AS-20230821153401

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(a)(3) · Plan of correction due date: Dec 29, 2023

87633 Hospice Care of Terminaly Ill Residents (a) The licensee shall... retain residents who... (3) Hospice agency services are contracted for by each terminally ill resident … not by the licensee on behalf of a resident. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above in one (01) out of five (05) residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2023

Plan of correction: Hospice services of Resident #1 (R1) were terminated on 08/18/2023. Licensee to conduct in-service training regarding the cited section and submit proof by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(h)(3) · Plan of correction due date: Dec 29, 2023

87633 Hospice Care of Terminally Ill Residents (h) ... the licensee shall maintain the following in the resident’s record: (3)...the written certification statement of the resident’s terminal illness from... the individual’s attending physician Based on interviews and record review, the licensee did not comply with the section cited above in one (01) out of five (05) residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2023

Plan of correction: Hospice services of R1 were terminated on 08/18/2023. Licensee to conduct in-service training regarding the cited section and submit proof by the POC due date.

Type of visit: Case Management - Deficiencies

At 8 :00 a.m. on 12/20/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit for complaint # 31-AS-20230821153401. LPA met with Staff #1 (S1) and later the administrator at approximately 8:30 a.m. and disclosed the reason for the visit. During the course of investigation, other deficiencies were discovered in the facility. Therefore, this case management visit was conducted to address the deficiencies discovered. During a record review at 8:15 a.m. today, it was discovered that Resident #1 (R1) and Resident #2 (R2) were enrolled in hospice services on 07/07/2023 and 06/21/2023. The plans of care were signed by a registered nurse, a medical social worker, a spiritual counselor, and a medical director, but were not signed by the licensee, R1, R2, or their responsible parties. This deficiency is cited on the attached LIC 809-D page. Records detailing facility personnel duties, hospice visits, and personnel trainings were not maintained or included in hospice records in the facility. Resident #3 (R3) and Resident #4 (R4) are enrolled in hospice services but did not have hospice care plans maintained in the facility. The administrator contacted the hospice agency for the care plans at 9:00 a.m. today. This deficiency is cited on the attached LIC 809-D page. Roommate acknowledgements of hospice services for R1, R2, R3, and R4 were not maintained or available at the facility. This deficiency is cited on the attached LIC 809-D page. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Dec 20, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(a)(4) · Plan of correction due date: Dec 29, 2023

87633 Hospice Care of Terminally Ill Residents (a) The licensee shall... (4) A written hospice care plan ... is developed for each terminally ill resident ... by that resident’s hospice agency and agreed to by the licensee and the resident. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in two (02) out of five (05) residents which poses a Health, Safety, or Personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2023

Plan of correction: Licensee to obtain signatures on care plans and submit proof by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87633(a)(6) · Plan of correction due date: Dec 29, 2023

87633 Hospice Care of Terminally Ill Residents (a) The licensee shall ... (6) The hospice agency and the resident... agree to provide the licensee with all information necessary to allow the licensee to comply with all regulations.This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in two (02) out of five (05) residents which poses a Health, Safety, or Personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2023

Plan of correction: Licensee to obtain complete care plans and related documents and submit proof by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(h)(5) · Plan of correction due date: Dec 29, 2023

87633 Hospice Care of Terminally Ill Residents (h) For each terminally ill resident...(5) A statement signed by the resident's roommate... indicating his or her acknowledgment. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in four (04) out of five (05) residents which poses a Health, Safety, or Personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2023

Plan of correction: Licensee to obtain roomate acknowledgements and maintain them in the faiclity files. Proof of correction due by POC due date.