191290706-9-26-2023-31-AS-RVAA-CW2R2M-20230926123834

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191290706
Report Date: 09/26/2023
Date Signed: 09/26/2023 12:40:22 PM

Document Has Been Signed on 09/26/2023 12:40 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:	HAMILTON HOUSE		FACILITY NUMBER:	191290706
ADMINISTRATOR:	PETERSON, JANICE		FACILITY TYPE:	735
ADDRESS:	739 W. GLENOAKS BLVD.		TELEPHONE:	(818) 502-9188
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91202
CAPACITY: 11		CENSUS: 7	DATE:	09/26/2023
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Carlos Correa, 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: HAMILTON HOUSE	FACILITY NUMBER: 191290706
	VISIT DATE: 09/26/2023

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BRIEF HISTORY: The facility Hamilton House has been in operation since licensure on 07/23/1995. The Licensee has also operated David Gogian House (197602168) since 03/09/1999 and Alma House (191221667) since 05/15/1991.

Since then, the facility has accrued more deficiencies:

- Reporting Requirements and Other Deficiencies-Hamilton House

- 2/15/2023- LPA Angela Panuskina conducted a Case Management visit and issued a Type B deficiency under CCR 85061(b)(1-3)(A)

- 6/12/2023- LPA Gary Tan conducted a Complaint Investigation and issued the following deficiencies under CCR 80072(a)(2) and CCR 80087(a)

- 7/06/2023- LPA Michael Cava conducted a Complaint Investigation and issued the following Type B deficiencies under the Health and Safety Code 80026(d)

- 8/03/2023- LPA Tuesday Cabiness conducted a Case Management visit in conjunction with a complaint and issued the following Type B deficiencies under CCR 87405(a) and CCR 87307(a)

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

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: HAMILTON HOUSE	FACILITY NUMBER: 191290706
	VISIT DATE: 09/26/2023

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Carlos Correa and Danika Lewis and requested the documentation/declaration in reference to former Administrator Paula Peterson’ 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.

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, 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 CCLD.

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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