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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191222081
Report Date: 12/19/2022
Date Signed: 12/19/2022 05:40:36 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
11/28/2022 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20221128101748
FACILITY NAME:ARARAT HOME OF LOS ANGELESFACILITY NUMBER:
191222081
ADMINISTRATOR:RITA NORAVIANFACILITY TYPE:
741
ADDRESS:15105 MISSION HILLS RD.TELEPHONE:
(818) 365-3000
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY:186CENSUS: DATE:
12/19/2022
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Rita Noravian TIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Facility failed to follow reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tihesha conducted a complaint visit to this facility on 12/19/2022 at 10:05 am to deliver findings.
During initial visit, on 12/06/22, LPA Smith interviewed the administrator and director from approximately 11:00 am-11:40 am. LPA Smith also requested pertinent documents related to the investigation from approximately 12:00 pm-1:31 pm information and conducted a physical plant tour to ensure there are no immediate health and safety issues from approximately 2:25 pm- 3:00 pm.
Facility failed to follow reporting requirements
It was alleged that the facility failed to follow reporting requirements. Interviews with administrators revealed that they did not fill out any incident report regarding the scabies incident. Therefore, there was a scabies issue at the facility and the administrator failed to follow up with reporting it to proper authorities.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
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 5
Control Number 31-AS-20221128101748
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: ARARAT HOME OF LOS ANGELES
FACILITY NUMBER: 191222081
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2022
Section Cited
CCR
87211(a)(2)
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87211(a)(2) Reporting Requirements. Within 24 hours the licensee shall notify the licensing agency (and the local health officer, if appropriate) if an epidemic outbreak, poisoning, catastrophe, or major accident which threatens the welfare, safety, or health of residents, personnel or visitors occurs.
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Administrator will send written statement that all incidents will be reported in the required timeframe.
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This requirement was not met as evidenced by:Based on facility failed to submit written incident report which posed a potential health and safety risk to clients 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.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20221128101748
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: ARARAT HOME OF LOS ANGELES
FACILITY NUMBER: 191222081
VISIT DATE: 12/19/2022
NARRATIVE
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(cont from 9099)


Based on the interviews during this and previous licensing visits there is sufficient pertinent information to support the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Exit interview conducted/Copy of Report and Appeal Rights given
Under Title 22 Regulations, following citations were issued and recorded on LIC9099D
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
11/28/2022 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20221128101748

FACILITY NAME:ARARAT HOME OF LOS ANGELESFACILITY NUMBER:
191222081
ADMINISTRATOR:RITA NORAVIANFACILITY TYPE:
741
ADDRESS:15105 MISSION HILLS RD.TELEPHONE:
(818) 365-3000
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY:186CENSUS: DATE:
12/19/2022
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Rita Noravian TIME COMPLETED:
05:45 PM
ALLEGATION(S):
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9
Facility failed to properly treat scabies outbreak
Staff failed to provide proper medication assistance to the residents
INVESTIGATION FINDINGS:
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Facility failed to properly treat scabies outbreak
It was alleged that the facility failed to properly treat scabies outbreak. LPA conducted interviews administrator and staff. The complainant was also contacted. The administrator confirmed that there were three (3) clients in the facility that had scabies. Administrator revealed that clients were isolated in room away from community population, linens were wash and sterilized, and medications were administered. County Personnel (Dept of Public Health) visited facility due to being notified of scabies outbreak and left Scabies prevention control and guidelines booklet with administrator. Per review of Scabies prevention guidelines, facility was following protocols for scabies outbreak

Based on the interviews and documentation received during this and previous licensing visits there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20221128101748
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: ARARAT HOME OF LOS ANGELES
FACILITY NUMBER: 191222081
VISIT DATE: 12/19/2022
NARRATIVE
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(Cont from 9099A)

Staff failed to provide proper medication assistance to the residents

It was alleged that staff failed to provide proper medication assistance to residents. LPA interview with S2 revealed Client #1(C1) is their client and any medications that are prescribed by the clients’ physician is overseen by the clients assigned Ararat Medical Coordinator. The assigned coordinator provides the assistance to the client. S2 revealed that when C1 was prescribed a cream for itching, they followed the application instructions to care for their client. S2 also revealed that C1’s medication was properly stored at all times except when being administered to the C1. LPA interview with S3 revealed that Client #2 (C2) and Client #2 (C3) are their clients and medications that are prescribed by the clients’ physician is overseen by the clients’ assigned Ararat Medical Coordinator.

Based on the interviews and documentation received during this and previous licensing visits there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha SmithTELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5