197610362-6-4-2026-31-AS-NMAN-DUXNEH-20260611102355

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610362
Report Date: 06/04/2026
Date Signed: 06/04/2026 04:53:27 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
04/24/2026 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20260424083220

FACILITY NAME:	ANTORIA ASSISTED LIVING OF TARZANA		FACILITY NUMBER:	197610362
ADMINISTRATOR:	CAMPOS, MARYCEL		FACILITY TYPE:	740
ADDRESS:	5912 CAHILL AVENUE		TELEPHONE:	(626) 840-2830
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	6	CENSUS: 3	DATE:	06/04/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Iha Solihat		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not change residents briefs timely resulting in a rash
Staff do not assist resident with showers

INVESTIGATION FINDINGS:

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At approximately 9:00 a.m. on 06/04/26 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 04/29/26 and toured the facility inside and out at 2:20 p.m., interviewed two (02) staff and the administrator between 2:30 p.m. and 3:30 p.m., and 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 3:00 p.m. LPA conducted a subsequent visit on 05/07/26 and toured the facility inside and out at 9:15 a.m. and interviewed residents between 9:00 a.m. and 10:30 a.m. Today, LPA toured the facility at approximately 10:00 a.m.

Regarding the allegation "Staff do not change resident’s briefs timely resulting in a rash" it was alleged Resident #1 (R1) acquired a rash due to insufficient incontinence care. Interview with R1 at 10:15 a.m. on 05/07/26 revealed they were unsure if they had a rash.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

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

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
04/24/2026 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20260424083220

FACILITY NAME:	ANTORIA ASSISTED LIVING OF TARZANA		FACILITY NUMBER:	197610362
ADMINISTRATOR:	CAMPOS, MARYCEL		FACILITY TYPE:	740
ADDRESS:	5912 CAHILL AVENUE		TELEPHONE:	(626) 840-2830
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	6	CENSUS: 3	DATE:	06/04/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Iha Solihat		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not ensure resident call button works properly

INVESTIGATION FINDINGS:

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At approximately 9:00 a.m. on 06/04/26 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit.

To investigate the allegation above, LPA conducted an initial visit on 04/29/26 and toured the facility inside and out at 2:20 p.m., interviewed two (02) staff and the administrator between 2:30 p.m. and 3:30 p.m., and 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 3:00 p.m. LPA conducted a subsequent visit on 05/07/26 and toured the facility inside and out at 9:15 a.m. and interviewed residents between 9:00 a.m. and 10:30 a.m. Today, LPA toured the facility at approximately 10:00 a.m.

Regarding the allegation "Staff do not ensure resident call button works properly" it was alleged the call button of Resident #1 (R1) was not working. Interview with R1 at 10:15 a.m. on 05/07/26 confirmed their call button did not work, so they threw it.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20260424083220

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: ANTORIA ASSISTED LIVING OF TARZANA	FACILITY NUMBER: 197610362
	VISIT DATE: 06/04/2026

NARRATIVE

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R1 said they received sufficient and timely assistance from staff without the call button. Interview with the administrator at 3:45 p.m. on 04/29/26 revealed R1 broke their call button. R1 also overused their call button at night which disturbed other residents. The administrator instructed staff to respond to R1’s verbal calls for assistance. Interviews with Staff #1 (S1) at 2:30 p.m. and Staff #2 (S2) at 2:45 p.m. on 04/29/26 revealed staff always responded to R1’s requests for assistance within two (02) minutes. LPA tested R1’s call button at approximately 10:30 a.m. on 05/07/26 and confirmed it did not work. R1 requested staff assistance verbally at approximately 10:31 a.m. on 05/07/26, and staff responded within thirty (30) seconds. LPA tested other resident call buttons during the facility tour at 9:15 a.m. on 05/07/26 which revealed four (04) out of five (05) call buttons were operational. Interviews with four (04) out of five (05) residents revealed their call button were operational. Based on observations and interviews, staff did not ensure R1’s call button worked properly. However, staff provided timely assistance to R1. Therefore, the allegation is SUBSTANTIATED, but no deficiency is issued due to proper care and supervision provided.

No immediate health or safety concerns observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 31-AS-20260424083220

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: ANTORIA ASSISTED LIVING OF TARZANA	FACILITY NUMBER: 197610362
	VISIT DATE: 06/04/2026

NARRATIVE

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R1 requested to be changed every hour, but staff told them they would change R1’s briefs about every three (03) hours. Interviews with four (04) out of four (04) other residents revealed only Resident #2 (R2) receives brief changing assistance from staff. Zero (00) out of four (04) have rashes. Interview with R2 at 9:10 a.m. on 05/07/26 revealed they have no issue with incontinence care, and staff assist them with changing “every few hours”. Interview with Staff #1 (S1) at 2:30 p.m., Staff #2 (S2) at 2:45 p.m., and the administrator at 3:45 p.m. on 04/29/26 revealed staff change R1 in a timely manner, and R1 has no rashes. Interview with S1 indicated they changed R1 in a timely manner and cleaned R1 during changings. Record review of R1’s care plan and medical assessment revealed they had a history of skin breakdown around their groin. Staff were to cleanse the area with warm water and pat dry after changings. Based on interviews and record review, the investigation did not reveal evidence of a rash or untimely changing of residents with incontinence care needs. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff do not assist resident with showers" it was alleged R1 did not feel comfortable showering with staff and had not received a shower in two weeks. Interview with R1 revealed they were not comfortable with staff for a few weeks, but that changed over time. Interviews with R1, S1, S2, and the administrator revealed although R1 does not receive a shower, S2 gives R1 a bed bath every day. Interviews with four (04) out of four (04) other residents revealed all residents were comfortable with staff and received sufficient assistance with bathing. R2 receives daily bed baths. Resident #3 (R3) and Resident #4 (R4) receive standby assistance for showers. Record review of R1’s care plan revealed staff were to provide “substantial” assistance by bathing and lifting limbs, which S2 did. LPA observations from interviews and facility tours on 04/29/26 and 05/07/26 revealed all residents appeared bathed and neatly groomed. Based on observations, record review, and interviews, staff provide sufficient bathing assistance to all residents based on their needs. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety concerns observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

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