195850126-2-13-2023-29-AS-DPEA-CQDTMZ-20230329145157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850126
Report Date: 02/13/2023
Date Signed: 02/13/2023 03:45:48 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/10/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20230210105225

FACILITY NAME:	GOLDEN CENTURY ASSISTED LIVING INC		FACILITY NUMBER:	195850126
ADMINISTRATOR:	SANDY KHAMBEKYAN		FACILITY TYPE:	740
ADDRESS:	13303 REEDLEY STREET		TELEPHONE:	(747) 264-0032
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY:	6	CENSUS: 2	DATE:	02/13/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Hripsime Tavitian, Akhtar Roshanaeian		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff took resident’s belongings.
Facility staff did not provide resident with adequate food service.
Facility staff does not provide residents with clean linens.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Emily Peraldi and Ashley Smith conducted an unannounced initial complaint visit at the facility today. At 10:00 a.m., the LPAs met with the Licensee and staff and explained the reason for the visit. The Licensee left during the time of the visit and authorized staff, Hripsime Tavitian to sign the report.

At 10:20 a.m., the LPAs conducted a physical plant tour. At 10:58 a.m., LPA Peraldi conducted an interview with the Licensee. Between 10:24 a.m., and 11:30 a.m., the LPAs conducted interviews with three (3) staff. Between 11:35 a.m. and 11:43 a.m., the LPAs interviewed two (2) out of two (2) residents.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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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Control Number 29-AS-20230210105225

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GOLDEN CENTURY ASSISTED LIVING INC	FACILITY NUMBER: 195850126
	VISIT DATE: 02/13/2023

NARRATIVE

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Regarding the allegation: Facility staff took resident’s belongings. It was alleged that Staff #1 (S1) stole five to six packs of cigarettes from Resident #1 (R1). Interview conducted on 02/13/2023 with R1 revealed that R1 believes that S1 stole the cigarettes that were given to R1. R1 stated that the cigarettes are in the staff room and that S1 is denying of having the cigarettes. Interview conducted on 02/13/2023 with S1, revealed that S1 does not know which cigarettes R1 is talking about. S1 stated that R1 received cigarettes from family, but it was given to the previous staff member not S1. S1 stated that they have never held onto R1’s cigarettes. S1 is unaware as to what happened to R1’s cigarettes prior to S1 working at the facility. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation: Facility staff did not provide resident with adequate food service. It was alleged that the facility staff are not providing food that is in quality and the quantity necessary to meet the needs of the residents. During the physical plant tour conducted on 02/13/2023, the LPAs observed adequate amount of perishable and non-perishable food. The LPAs observed a variety of proteins, fruits, and vegetables. Interview conducted with Resident #1 (R1) on 02/13/2023, revealed that staff usually prepares soup and sandwiches. However, when questioned if R1 request for something different, R1 stated that R1 does not ask or request for a change of food. Interview conducted with Staff #1 (S1) on 02/13/2023, S1 stated that they follow special request from residents and always includes fruits with each meal. S1 stated that the residents request sandwiches and additional servings of the food, which S1 does give. The LPAs reminded facility staff that the meals shall consist of an appropriate variety of foods. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation: Facility staff does not provide residents with clean linens. It was alleged that facility staff did not wash resident’s linens for a long period of time. During the physical plant tour conducted on 02/13/2023, the LPAs observed the facility and resident rooms which appeared to be clean and sanitary. The LPAs observed all the linens and bedsheets to be clean. Resident interviews conducted on 02/13/2023, revealed that the facility staff recently cleaned the facility on Saturday February 11, 2023.
Continued on LIC 9099-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230210105225

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GOLDEN CENTURY ASSISTED LIVING INC	FACILITY NUMBER: 195850126
	VISIT DATE: 02/13/2023

NARRATIVE

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Although residents alleged that the linens were not cleaned regularly, staff interviews stated that the staff clean the facility daily and wash resident clothing and linens on a consistent basis. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

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