191221667-9-26-2023-31-AS-RVAA-CW2R4S-20230926124202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191221667
Report Date: 09/26/2023
Date Signed: 09/26/2023 12:43:14 PM

Document Has Been Signed on 09/26/2023 12:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ALMA HOUSE		FACILITY NUMBER:	191221667
ADMINISTRATOR:	CORREA. CARLOS		FACILITY TYPE:	735
ADDRESS:	1123 ALMA STREET		TELEPHONE:	(818) 502-0929
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91202
CAPACITY: 6		CENSUS: 6	DATE:	09/26/2023
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Danika Lewis, Administrator		TIME COMPLETED:	12:30 PM

NARRATIVE

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An Informal Conference was conducted today at the Woodland Hills-South Adult and Senior Care Regional Office. This Informal Conference was held to discuss the licensee’s name change, financial records, the high volume of complaints and to find the possible solutions to remedy these issues.

Prior to the meeting, Licensee was given the chance to review the facility file.

Present at today’s meeting were the following:

- Nancy Niebrugge, Executive Director

- Carlos Correa, Hamilton House Administrator

- Danika Lewis, David Gogian House Administrator

- Naira Margaryan, Licensing Program Manager (LPM)

- Rosaura Valenzuela, Licensing Program Analyst (LPA)

The informal conference process was explained to the Licensee. The Licensee was also informed that this Informal Conference is a part of the administrative action process. Further citations may result in a Non-Compliance Conference, which could lead to a referral to the Department’s Legal Division for possible license revocation or other administrative actions.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALMA HOUSE	FACILITY NUMBER: 191221667
	VISIT DATE: 09/26/2023

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BRIEF HISTORY: The facility Alma House has been in operation since licensure on 5/15/1991. The Licensee has also operated David Gogian House (197602168) since 03/09/1999 and Hamilton House (191290706) since 7/23/1995 .

Since then, the facility has accrued more deficiencies:

-9/21/2023- LPA Alberto Lopez conducted an Annual visit and issued the following deficiencies Type A under CCR 80088(e)(1), CCR 80065(f)(4, and Type B under CCR 8088(e)(3), CCR 80087(a), and 85088(c)(2).

9/15/2023- LPM Naira Margaryan contacted Nancy Niebrugge, Executive Director and requested the financial records of both facilities Hamilton House and David Gogian House. Also, discussed the change in Licensee name.

During prior Licensing Visits LPA Valenzuela was informed that former facility administrator was coming to the facility uninvited, and most residents are getting frustrated by her presence. In addition, LPA and LPM spoke with the Administrators Carlos Correa and Danika Lewis and requested the documentation/declaration in reference to former Administrator Paula Petersons' improper actions.

Prior to this meeting the Regional Executive Director Nancy Niebrugge, provided the copies of the internal audit records pertaining misusage of clients P&I finances as well as other possible financial issues. In addition, ED provided the documents for all 3 facilities for corporation change.

The ED and administrators assured CCLD representatives that they will do everything in their power to bring the facilities into compliance under Title 22 regulations.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALMA HOUSE	FACILITY NUMBER: 191221667
	VISIT DATE: 09/26/2023

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During this meeting, LPM Margaryan discussed with the facility representatives the need to provide lease back agreement for all three houses.

They were also informed that CCLD Auditing Department will review all the paperwork containing the financial records that have been submitted.

LPM told facility representatives to reach out to our office for any questions. In addition, if the Licensee has any documents that show that former administrator Paula Peterson had inappropriate behavior, conduct inimical, and is harassing clients to submit those files. The Department is trying to exclude Paula Peterson as Administrator.

In addition, during this meeting we discussed substantiated complaints and the deficiencies that have been issued. It was also discussed that Plan of Corrections need to be submitted and cleared in a timely manner. Also, all serious incident reports need to be submitted to CCL.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

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