Woodland Hills Retirement Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 11:00AM. Upon arrival, LPA met with staff and Administrator Serguei Kalistratov who arrived at 11:40AM. Entrance interview conducted. At 11:29AM, the LPA along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN/GARAGE: The LPA inspected the kitchen/food service area at 11:29AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and nonperishable food. Food labels were inspected and checked for expiration dates and food labels had expiration date clearly marked. Knives were locked inaccessible in a kitchen drawer. Fire extinguisher was fully charged and last serviced 03/12/2026. The attached garage is kept locked and inaccessible and contains an additional refrigerator/freezer, laundry, nonperishable food, and supplies. BEDROOMS: There are six (6) private resident bedrooms. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are three (3) restrooms. Restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Hot water temperatures were measured in client bathrooms and were between 105.1-108.1 degrees F, which is within the required range. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, living room and dining area furniture were observed to be in good condition. The facility maintained a comfortable temperature. At 11:51AM, smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. LPA observed required postings throughout the common spaces. OUTDOOR AREA: LPA observed the back patio which has a covered area for resident use. There is a self-latching gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. There are no bodies of water on the premises. MEDICATION REVIEW: At 11:54AM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in a cabinet by the dining area. All medications including PRNs were labeled, stored, and locked inaccessible to residents. LPA observed the centrally stored medication and destruction records (CSMDRs) for two (2) residents that were missing medication quantity and had medications with start dates logged as future dates. LPA also observed weekly pill organizers being utilized instead of medications being stored in their originally received containers. LPA observed several medications from bubble packs that were popped out and taped back rather than destroyed. Quetiapine Fumarate 50mg 1 tab twice daily quantity of 30 for Resident #1 (R1) had a start date of 05/25/2026, however, only twelve (12) pills were observed during medication review on 05/26/2026 instead of twenty-seven (27). Administrator stated that there might have been an error in logging the start date. Administrator stated he will conduct medication training with all staff and the facility will no longer utilize the pill organizers to prepare medications in advance; medications will be kept and administered from their bottles. RECORD REVIEW: Beginning at 02:20PM, LPA reviewed five (5) out of five (5) resident files and four (4) personnel files for documents including but not limited to: medical records, care plans, health screening, staff training and fingerprint clearance. All resident and personnel files were in order. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control policy and emergency disaster plan. Emergency disaster plan is updated annually as required and emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 04/12/2026. All documents reviewed were updated and in compliance. The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. Administrator was informed that failure to correct deficiency may result in civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 26, 2026

Allegation investigated: Facility staff did not provide a refund

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation at 01:55PM. Upon arrival, LPA met with staff and Administrator Assistant (AA) Irina Fried. Entrance interview conducted. During today’s visit, LPA Barutyan conducted a brief physical plant tour and reviewed and obtained copies of pertinent documents. During the initial visit on 01/15/2025, LPA conducted a brief physical plant tour, conducted interviews with three (3) staff and discussed allegation with Licensee Serguei Kalistratov. It was alleged that the facility did not provide a refund for pro-rated days after Resident #1 (R1) moved out of the facility. R1 voluntary moved out of the facility on 11/25/2024. Full monthly rent for November 2024 was paid 11/01/2024. CONTINUED ON LIC 9099-C. Unsubstantiated LPA reviewed R1’s signed admission agreement dated 08/14/2024. Per the admission agreement, “REFUND POLICY: Payment is made on the basis of the principle of ‘monthly payment.’ All charges for 'Basic Services' are due on the last day of each month. The Admission and Assessment fee is fully refundable.” The agreement does not specify facility refund policy concerning resident voluntary relocation or termination of the agreement for other reasons besides death of resident. The facility did not state in the signed agreement that pro-rated fees shall be refunded or that a move-out notice is required. Interviews with Licensee, AA, and R1’s responsible party confirmed that the facility agreed to refund the five (5) pro-rated days for November 2024 on 12/18/2024. During LPA’s initial visit on 01/15/2025, LPA observed the check refund held at the facility. The check was issued to R1 in the amount of $905.00 for five (5) days. Licensee stated that the check had not been mailed yet due to delays from the holiday season and the Pacific Palisades fires resulting in the facility’s evacuation. LPA reviewed communications between Licensee and R1’s responsible party which documented that multiple attempts for receiving/delivering the check refund were made from both parties between 12/18/2024-01/11/2025. LPA received and reviewed confirmation of the check mailed to R1’s responsible party via certified mail on 01/17/2025 and delivered on 01/21/2025. Based on record review, interview, and observation the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. 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 above allegation “Facility staff did not provide a refund” is deemed UNSUBSTANTIATED at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 1, 2025 · control 29-AS-20250113104134

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 09:55AM. Upon arrival, LPA met with staff and Administrator Assistant (AA) Irina Fried. Entrance interview conducted. At 09:56AM, the LPA along with the AA, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS: There are six (6) private resident bedrooms. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are three (3) restrooms. Restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The restrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. At 10AM, hot water in the shared bathroom between bedrooms #6 and #5 measured at 83.3 degrees F, which is not within the required range of 105-120 degrees F. At 10:02AM, hot water in bedroom #3’s bathroom measured at 134.4 degrees F. At 10:15AM, hallway bathroom by bedroom #1 measured at 146.1 degrees F. AA immediately lowered the water heater settings for both water heater tanks. AA stated that the shared bathroom between bedrooms #6 and #5 has hot water, but it takes a while to heat. AA stated they will monitor the hot water in bathrooms and will send a temperature log to LPA. LPA retested hot water in the hallway bathroom at 11:15AM and it measured at 138.9 degrees F. AA stated that it will take about 12 hours for the water heater settings to adjust to the change. Report Continued on LIC 809-C KITCHEN/GARAGE: The LPA inspected the kitchen/food service area at 10:16AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and nonperishable food. Food labels were inspected and checked for expiration dates and food labels had expiration date clearly marked. Knives and chemicals were locked inaccessible in kitchen drawer and under-the-sink cabinet. Fire extinguisher was fully charged and last serviced 05/16/2024. The attached garage is kept locked and inaccessible and contains an additional refrigerator/freezer, laundry area, nonperishable food, and additional supplies. COMMON AREAS: At the time of the visit, living room and dining area furniture were observed to be in good condition. The facility maintained a comfortable temperature of 73 degrees F. At 11:17AM, smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. Auditory exit alarm in the living room was off, AA replaced the batteries during the visit. LPA observed required postings throughout the common spaces. OUTDOOR AREA: LPA observed the back patio which has a covered area for resident use. There is a self-latching gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. There are no bodies of water on the premises. MEDICATION REVIEW: At 10:21AM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. RECORD REVIEW: Beginning at 10:46AM, LPA reviewed three (3) out of three (3) resident files and three (3) out of three (3) personnel files for documents including but not limited to: medical records, care plans, health screening, staff training and fingerprint clearance. All resident and personnel files were in order.INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. No documentation of quarterly emergency drills was provided. The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. Administrator was informed that failure to correct deficiency may result in civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 28, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Barutyan conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20250113104134). The purpose of the visit is to issue a citation for a deficiency observed during the initial complaint investigation. During the visit on 01/15/2025, LPA observed Staff #1 (S1) without a criminal record clearance. S1 stated to LPA that they are new and have been working at the facility for only one (1) day. However, Administrator Irina Fried stated that S1 began working at the facility a few weeks ago and is still in training. Per Administrator, S1 is a caregiver and also handles medications, therefore, S1 would need to obtain a criminal record clearance. LPA spoke with Licensee Serguei Kalistratov and Administrator at 12:45PM who stated that S1 began working and residing at the facility on 01/12/2025 when there were no residents residing at the facility due to evacuation orders on 01/09/2025 for the Palisades fire. However, per regulation, a criminal record clearance must be obtained prior to working or residing at the facility. Administrator stated that a livescan for S1 was submitted today and showed proof. The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. Civil penalties were issued in the amount of $300. Failure to correct the deficiency may result in additional civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jan 16, 2025

87355(e)(1) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption This requirement is not met as evidenced by: Based on observation, record review, and interview, Staff #1 did not have a criminal record clearance which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 15, 2025

Plan of correction: Administrator stated that fingerprints were submitted today and S1 will be associated. Administrator will submit proof by 01/16/2025 to CCL.

Allegation investigated: Staff did not dispense medication as prescribed by physician

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct an initial complaint investigation for the allegations listed above at 10:50AM. LPA met with staff and Licensee who arrived at 11:30AM. Entrance interview conducted. During today's visit, LPA conducted a brief physical plant tour at 10:53AM, interviewed two (2) residents and two (2) staff and attempted interviews with two (2) other residents, conducted a medication review for three (3) residents at 11:24AM, and reviewed and obtained copies of pertinent documents. At approximately 01:05PM, LPA discussed allegations with Licensee and Lead Caregiver. Report Continued on LIC 9099-C. Substantiated It was alleged that staff did not dispense medication as prescribed by physician. LPA conducted a medication review for three (3) residents between 11:24AM – 1:05PM. LPA observed the centrally stored medication and destruction record (CSMDR) for Resident #1 (R1) and observed three (3) medication errors. Medication counts for Melatonin 10 mg, Trazadone 50 mg, and Acetaminophen 15 mL were off and could not be accounted for. The administration instructions from the doctor’s order for the Acetaminophen stated “take 15 mLs by mouth every 6 hours Not to exceed 3000 mg Acetaminophen from all sources per 24 hours..indications: fever, pain, temp > 100F, mild pain 1-3/10.” Meanwhile, the instructions on the facility’s CSMDR stated “15 mLs every 6 hours/as needed.” The start date on the CSMDR was missing, however LPA observed a label on the bottle stating the medication was opened on 08/28/2024. Interviews with Staff #1 (S1), Lead Caregiver (LC), and Licensee Kalistratov revealed that that the Acetaminophen was not being administered every 6 hours as prescribed. LC stated that the medication was started on 08/28/2024 and was given once per day. However, the serving size is 15 mL and the bottle quantity is 473 mL, meaning that there are about 31.5 servings per bottle and therefore, the bottle would have finished around 09/28/2024 if administered as LC stated. The label also states that the medication is to be administered every 6 hours, not once per day. S1 and LC stated that R1 is asleep for most of the day and night, and they have difficulty waking the resident up for the medication, however, no documentation could be provided. S1, LC, and Licensee also stated that there were difficulties in interpreting the label since it says for pain and/or fever. S1, LC, and Licensee stated that the Acetaminophen was given routinely, however, LPA obtained evidence from credible sources revealing that the Acetaminophen was believed to be a PRN medication by the facility and is also why the medication count was off. Based on medication review, interviews, and record review, the allegation “Staff did not dispense medication as prescribed by physician” is deemed SUBSTANTIATED at this time. The following deficiency was observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Administrator was informed that failure to correct the deficiency may result in civil penalties. Licensee was unable to stay for the duration of the visit and designated staff Arystanbek Yeshibayev to sign the report. Exit interview conducted. Appeal rights and a copy of the report was provided. It was alleged that staff did not properly maintain resident’s medical records and that staff did not ensure resident’s medical records remained confidential. LPA observed resident records to be stored in locked cabinets in the kitchen. LPA reviewed resident records and observed records to be in order and compliance with regulation. LPA interviewed the Lead Caregiver (LC) who stated that resident records are confidential and only staff have the key to unlock the cabinet containing the files. LPA did not observe any records stored in a way that compromises confidentiality. It was further alleged that staff did not properly secure residents’ medication. LPA observed a locked medication cabinet in the locked garage. The cabinet was transparent, and medications could be observed without unlocking the cabinet. Staff stated that the cabinet was originally centrally stored in the kitchen and was moved to the garage on 10/26/2024. Per regulation, medications shall be stored inaccessible, and the medications stored in the transparent medication cabinet are inaccessible as they are kept locked. Although the cabinet is transparent, residents and other parties are unable to access the medications. Based on observation, interviews, and record review, the Department does not have sufficient evidence to corroborate the allegations. Although the allegations may be valid, at this time there is insufficient evidence to support the allegations or that violations occurred, therefore, the allegations “Staff did not properly maintain resident’s medical records,” “Staff did not ensure resident’s medical records remained confidential,” and “Staff did not properly secure residents’ medication”” are deemed UNSUBSTANTIATED at this time. Licensee was unable to stay for the duration of the visit and designated staff Arystanbek Yeshibayev to sign the report. Exit interview conducted. Copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 29-AS-20241029131721

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(4) · Plan of correction due date: Oct 31, 2024

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws... This requirement is not met as evidenced by: Based on interviews and medication and record reviews, the licensee did not comply with the section cited above as 3 medications were not properly maintained which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Licensee contacted a hospice nurse to discuss medications on 10/27/2024. Licensee is an LVN and will conduct medication training to all staff and submit proof to CCL by 10/31/2024.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Barutyan conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20241029131721). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation. During the visit on 10/30/2024, LPA conducted a medication review at 11:24AM. LPA observed PRN medications for three (3) residents which were not properly logged. Staff were unable to confirm which medication packs the PRN medications were administered from as the Rx number, date filled, and date expired were not logged. LPA also observed medications prepped and stored in medication pill boxes three (3) days in advance. Staff were unable to confirm which medication packs the medications in the pill boxes were prepped from as the medication packs had been thrown away. Review of the facility’s LIC 500 Personnel Report documented two (2) staff members without a criminal record clearance. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Civil penalties were issued in the amount of $1000. Failure to correct the deficiencies may result in additional civil penalties. Licensee was unable to stay for the duration of the visit and designated staff Arystanbek Yeshibayev to sign the report. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 30, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Oct 31, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as two employees were observed without a criminal record clearance which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Licensee stated that the two staff are associated to his other facility and will transfer their criminal record clearance by today. Licensee will submit proof to CCL by 10/31/2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(5) · Plan of correction due date: Oct 31, 2024

87465 Incidental Medical and Dental Care (h)The following requirements shall apply to medications...: (5)Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as medications were stored in pill boxes three days in advance which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Licensee stated that they will conduct a meeting with all staff to discuss medication preparation and storage. Licensee will submit proof to CCL by 10/31/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(d) · Plan of correction due date: Nov 7, 2024

87465 Incidental Medical and Dental Care (d)If the resident is unable to determine his/her own need for a...PRN medication...facility staff...shall be permitted to assist the resident...provided all of the following requirements are met: This requirement is not met as evidenced by: Based on medication review, the licensee did not comply with the section cited above as PRN medications for 3 residents were not properly logged which poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Licensee stated they will conduct training with staff to address PRN medication logging to ensure that Rx number, date filled, and date expired are logged. Licensee will submit proof to CCL by 11/07/2024.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA met with staff and explained the reason for the visit. The Administrator Serguei Kalistratov was not available, and the facility representative Irina Fried arrived at 11:45 a.m. The LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and were found to be good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced on 05/16/2024. The facility smoke alarm system is hardwired and operated normally at the time of visit. Medications were observed to be locked in a cabinet by the kitchen area. KITCHEN: Kitchen knives are stored in a locked drawer by the kitchen. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (-6*F) and the refrigerator was maintained at 33*F degrees Fahrenheit. The supply of perishable and nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen cleaning supplies are stored locked under the sink. Hot water in kitchen was measured at normal regulation levels.BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Lighting in the rooms appeared adequate. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are six (6) total bedrooms for resident use – all resident rooms are private rooms.There was a linen closet in the hallway with extra towels and linens. Continues on LIC 809C... RESTROOMS: There are three (3) bathrooms at the home. Two private resident bathrooms, and one hallway bathroom, all had non-skid mats. The toilet and shower have grab bars. During the visit, the LPA observed signs in all of the bathrooms pertaining to proper hand hygiene. All cleaning supplies were inaccessible to client in care. In addition, restroom hot water measured 115.5 degree F. OUTDOOR AREA: The garage door was observed to be locked from the outside and inside door from the kitchen area. Washer and dryer are located inside the garage area. The LPA observed a cabinet with laundry cleaning supplies. The backyard has a covered outdoor area equipped with furniture for client use. There were no bodies of water noted. RECORDS: Records review began at 12:27 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 1:25 p.m. Medications are centrally stored and locked in a cabinet in the kitchen area; medications are labeled and checked for expiration dates. Three out of three medication bottles Pantoprazole, Atorvastatin and Amlodipine were missing information (quantity of pills) and Date Started in the LIC622. Additionally, the medication Amlodipine was found to be incorrectly stored in a pill box: Both in AM and PM section compartments. The pill is to be taken once a day. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Deficiencies were cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, May 30, 2024