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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 03:16:50 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
06/21/2022
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20220621165644
FACILITY NAME:
BROOKDALE CHATSWORTH
FACILITY NUMBER:
191221435
ADMINISTRATOR:
ADAM SYNCHEFF
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:
10:00 AM
MET WITH:
Lilit Mnatsaykanyan
TIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's blood is being drawn without permission.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with the administrator Lilit Mnatsaykanyan and explained the reason for this visit.
LPA conducted a physical plant walk through to ensure no immediate health and safety issues were present. No health and safety issues were noted during this visit.
It is alleged that resident #1 (R1) is having their blood drawn without their permission. LPA conducted an interview with the administrator and facility staff from approximately 10:30-11am regarding this allegation. LPA interviewed R1 regarding this allegation from 11:30-12pm. LPA also reviewed facility documents and obtained copies of those documents from 12-12:15pm. Information from interviews reveal that there is no issue with R1's blood being drawn without their permission. R1 stated they have no issues with the facility and the issues they have are unrelated to the care they are receiving at the facility. Based on the information obtained through interviews and documentation reviewed 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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