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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610429
Report Date: 05/19/2026
Date Signed: 06/02/2026 03:04:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/11/2026 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20260511130957
FACILITY NAME:SIMPLE TOUCH BOARD AND CARE INCFACILITY NUMBER:
197610429
ADMINISTRATOR:SARKISYAN, KARINEFACILITY TYPE:
740
ADDRESS:22317 MOBILE STTELEPHONE:
(747) 444-8506
CITY:CANOGA PARKSTATE: CAZIP CODE:
91303
CAPACITY:6CENSUS: 3DATE:
05/19/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ainur Zhailauova, StaffTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff do not prevent resident from wandering from the facility
INVESTIGATION FINDINGS:
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This is an Amendment to the original report issued 05/19/2026. Additional information was added to clarify the investigation.

At 10:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced initial
10-day complaint investigation regarding the above allegation. The LPA met with the Administrator and
explained the reason for the visit.

During course of the investigation, interviews and record review were conducted. At 10:05am, LPA requested resident and staff roster. At 10:10am, LPA requested copies of pertinent information which included but not limited to Admission Agreement, Physician’s Report, Preplacement Appraisal Information and Appraisal Needs and Services Plan, relevant to the investigation. However, LPA observed that all documents are incomplete and missing dates and signatures.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
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 3
Control Number 31-AS-20260511130957
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SIMPLE TOUCH BOARD AND CARE INC
FACILITY NUMBER: 197610429
VISIT DATE: 05/19/2026
NARRATIVE
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At approximately 10:25am, the 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.

Between 10:30am – 11:30am, the LPA conducted an interview with the Administrator, two (2) witnesses and attempted to interview one (1) out of three (3) residents.

Allegation: Staff do not prevent resident from wandering from the facility

The facility is alleged to have failed to provide adequate supervision to Resident 1 (R1), who has a mental health diagnosis, a history of wandering, and is not supposed to leave unassisted. Witnesses reported seeing R1 walking alone in the neighborhood on multiple dates (04/28/26, 05/08/26, and 05/09/26), with emergency services contacted each time. The Administrator acknowledged that staff cannot physically stop R1 due to combative behavior and only observe R1 from a distance rather than preventing elopement. No plan was provided to address R1’s exit-seeking behavior (i.e. develop and implement a formal care plan for R1, increase staff monitoring, implement structured engagement activities, debrief and train staff, notify and collaborate with healthcare professionals, etc.). The Administrator was also unable to provide staff training in dementia-related behaviors and non-physical redirection techniques. Lastly, LPA conducted record reviews and observed that R1’s Pre-placement Appraisal was incomplete and unsigned, and the Physician’s Report—which stated R1 could leave unassisted—was missing a physician’s signature, rendering it invalid. Therefore, based on interviews and facility record reviews, this allegation is Substantiated.


Deficiencies issued per Title 22.

Exit interview conducted appeal rights explained and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20260511130957
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SIMPLE TOUCH BOARD AND CARE INC
FACILITY NUMBER: 197610429
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2026
Section Cited
CCR
87468.2(4)
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Additional Personal Rights for Residents in Privately Operated Facilities: (4) To care, supervision, and services... and are delivered by staff that are sufficient in numbers qualifications, and competency to meet their needs. This requirement is not met as evidenced by:
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Administrator agreed to schedule vendorized training for all staff and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion
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Based on LPAs record review and observation, licensee did not comply with the section cited above by failing to properly conduct R1's pre-assessment and to assure that the staff is trained to provide proper care and supervision to meet R1's needs. This poses an immediate health, safety risk to persons in care.
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Type A
05/20/2026
Section Cited
CCR
87405(d)(1-5)
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Administrator Qualifications: d) The administrator shall have the qualifications... all requirements for an administrator shall apply. 1)Knowledge of the requirements for providing care and supervision appropriate to the residents...
This requirement is not met as evidenced by:
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Administrator agreed to schedule vendorized training for all staff and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion
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Based on interviews and record reviews the licensee did not comply with the section cited above by failing to provide appropriate care and supervision to R1, submit incident reports in a timely manar, provide appropriate trainilng to staff, have the staff associated/fingerprinted prior to employement, etc., which poses an immediate health, safety risk to 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.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC9099 (FAS) - (06/04)
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