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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
191221435
Report Date:
06/24/2022
Date Signed:
06/24/2022 03:15:38 PM
Unsubstantiated
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
03/16/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20210316164810
FACILITY NAME:
BROOKDALE CHATSWORTH
FACILITY NUMBER:
191221435
ADMINISTRATOR:
CHAPARYAN, LILIT
FACILITY TYPE:
740
ADDRESS:
20801 DEVONSHIRE BLVD
TELEPHONE:
(818) 341-2552
CITY:
CHATSWORTH
STATE:
CA
ZIP CODE:
91311
CAPACITY:
268
CENSUS:
122
DATE:
06/24/2022
UNANNOUNCED
TIME BEGAN:
12:30 PM
MET WITH:
Lilit Mnatsakanyan
TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mentally abused resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegation above. LPA met with administrator Lilit Mnatsakanyan and explained the reason for this visit.
It is alleged that resident #1 (R1) was mentally abused by staff. LPA conducted an interview with R1 from regarding the complaint allegation from 12:50-1:30pm. LPA conducted interviews with facility staff regarding the complaint allegation from from 12:30-12:45pm. LPA obtained and reviewed information from R1's facility file. Information from interviews conducted reveal that R1 did have an issue with the facility over medication management that is being addressed in another complaint (31-AS-20210628140259) but there is no issue regarding R1 being mentally abused by any staff. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time. Exit Interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099
(FAS) - (06/04)
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