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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610094
Report Date: 08/10/2026
Date Signed: 08/10/2026 03:42:04 PM

Substantiated


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
07/31/2026 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20260731094111
FACILITY NAME:WELLNESS ASSISTED LIVINGFACILITY NUMBER:
197610094
ADMINISTRATOR:MELIKSETYAN, LUSINEFACILITY TYPE:
740
ADDRESS:9115 N WYSTONE AVETELEPHONE:
(747) 218-9141
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 6DATE:
08/10/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Elmira Arymbakieva- StaffTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are unable to communicate with residents
Uncleared staff provided care to residents
Licensee raised fees without required notice period
INVESTIGATION FINDINGS:
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Licesing Program Analyst (LPA) Mariana Agban arrived at the above facility to conduct intitial complaint visit. Upon entrace LPA was greeted by Staff #1 (S1). Adminstator was contacted and the reason for the visit was explained. LPA was informed that the Administor wasn't able to come to the facility and there was no Administrator Designee in place.LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. During today's visit, LPA interviwed two (2) residents and attempted for four (4) residents. In addtion, LPA interviwed Administrator and attempted to interview S1.

Regarding the Allegation: Staff are unable to communicate with residents.
It is alleged that all facility staff speak only Russian and that staff use a translation application on their phones to communicate with residents.During today's visit, the LPA attempted to interview Staff 1 (S1). S1 stated that S1 does not understand English and requested that the LPA use a translation service on S1's phone to translate the LPA's questions into Russian. (Continue on LIC 9099C.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026
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 4
Control Number 31-AS-20260731094111
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: WELLNESS ASSISTED LIVING
FACILITY NUMBER: 197610094
VISIT DATE: 08/10/2026
NARRATIVE
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Interviews with two (2) residents confirmed that staff are unable to effectively communicate with residents and that staff use translation services on their phones to communicate with residents. Based on the information obtained through interviews, the allegation is deemed SUBSTANTIATED at this time.

Regarding the Allegation: Uncleared staff provided care to residents

It is alleged that uncleared staff are providing care and supervision to residents. Interview with the Administrator revealed that Staff 1 (S1) does not have a criminal record clearance and is still in the process of being hired. LPA advised the Administrator that all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) must obtain the required criminal record clearance prior to working in a licensed facility.Based on the information obtained through interviews and record review, the allegation is deemed SUBSTANTIATED at this time.

Regarding the Allegation: Licensee raised fees without required notice period.

It is alleged that the Licensee notified R1's responsible party by text message of an increase in R1's monthly rate from $2,000 to $2,500, effective July 14, 2026, without providing an explanation for the increase or the required written notice. Interview with the Licensee revealed that the rate increase was communicated to R1's responsible party via text message. The Licensee stated that the increase was due to the cost of living. LPA conducted a review of the facility records and found no documentation indicating that the required notice of the rate increase had been provided. Interviews with residents did not independently confirm the allegation. Based on the information obtained through interviews and record review, the allegation is deemed SUBSTANTIATED at this time.


Per California Code of Regulations, Title 22, Division 6, Chapter 8, the facility is being cited on the attached LIC 9099D. An exit interview was conducted, a copy of this report is provided and Appeal Rights is also provided.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 31-AS-20260731094111
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: WELLNESS ASSISTED LIVING
FACILITY NUMBER: 197610094
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/17/2026
Section Cited
CCR
87411(d)(3)
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87411-Personnel Requirements - General-(d)(3)Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents.,.This requirement is not met as evidenced by:
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Administrator/License agrees to put in writing their plan ensuring English-speaking staff are always on shift and submit the plan by the POC date
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Based on interviews staff was unable to communicate with LPA, Staff was using translation device. This poses a potential risk to the residents in care.
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Type B
08/17/2026
Section Cited
HSC
1569.655(a)
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(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives setting forth the amount of the increase and the reason or reasons for the increase, including a description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This requirement is not met as evidenced by:
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Administrator/License agrees to provide written notice of the rate increase and reasons for the increase to R1's responsible party and a copy to LPA by POC.
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Based on interviews and record review, Licensee did not provide written notice for the rate incraese and reasons for the increase. This poses a potential risk to the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20260731094111
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: WELLNESS ASSISTED LIVING
FACILITY NUMBER: 197610094
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/10/2026
Section Cited
HSC
87355(e)(2)
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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:(2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by;
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Licensee/ Administrator agreed to have S1 fingerprinted and associated with the facility. Proof of fingerprint clearance and association will be provided to LPA by 08/17/26.
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Based on interviews and record reviews, the Licensee hired S1 without obtaining fingerprint clearance. S1 has been working at the facility since 08/08/26. This poses an immediate risk to the health, safety, and personal rights of persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary G Flores
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4