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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
191221435
Report Date:
12/16/2020
Date Signed:
12/19/2020 01:10:04 AM
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
12/10/2020
and conducted by Evaluator
Elizabeth Arambulo
COMPLAINT CONTROL NUMBER:
31-AS-20201210113745
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:
68
DATE:
12/16/2020
UNANNOUNCED
TIME BEGAN:
08:24 AM
MET WITH:
Lily Chaparyan
TIME COMPLETED:
09:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents smoking inside the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Elizabeth Arambulo contacted administrator Lily Chaparyan regarding the above allegations. Due to the surge of the COVID-19 the visit was conducted by televisit.
The administrator was interviewed regarding the allegation. Administrators stated they do have two residents that smoke and the facility has house rules of no smoking in resident rooms or in the facility. They do have a designated smoking area and the residents have been observed taking a smoke break. The resident has abided by smoking in designated areas and they have done an internal investigation to see if anyone is smoking in their room. There was no proof of smoking in rooms. The administrator did state that the cigarette smell could be from the residents breathe and clothing. Based on the interview and information provided this allegation is Unsubstantiated.
Copy of report emailed to administrtor for signature and return.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Nichelle Gillyard
TELEPHONE:
(818) 596-4341
LICENSING EVALUATOR NAME:
Elizabeth Arambulo
TELEPHONE:
(818) 389-7921
LICENSING EVALUATOR SIGNATURE:
DATE:
12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/16/2020
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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