195850162-12-2-2021-29-AS-JAPL-CBRVYR-20220218155129

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850162
Report Date: 12/02/2021
Date Signed: 12/02/2021 05:48:52 PM

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
11/23/2021 and conducted by Evaluator Salia Walker

COMPLAINT CONTROL NUMBER: 29-AS-20211123163312

FACILITY NAME:	COMFORT ELDERLY CARE		FACILITY NUMBER:	195850162
ADMINISTRATOR:	MAKHTESYAN, DIANA		FACILITY TYPE:	740
ADDRESS:	22806 CALIFA STREET		TELEPHONE:	(818) 602-1622
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 4	DATE:	12/02/2021
		UNANNOUNCED	TIME BEGAN:	01:32 PM
MET WITH:	Cezar Tolentino, Designee		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff do not have background clearance

Facility does not provide laundry service

Facility is dirty

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Salia Walker and Elsie Campos conducted an unannounced initial 10-day complaint inspection for the above allegations. The LPAs met with at Designee Cezar Tolentino at 1:37 p.m., and explained the reason for the visit.

During today’s visit, the LPAs conducted a physical plant tour at 1:39 p.m. to ensure there are no health and safety hazards. From 2:09 p.m. until 2:34 p.m., the LPAs conducted interviews with two (2) staff. From 2:38 p.m. until 3:03 p.m., the LPAs conducted interviews with three (3) out of four (4) residents. From 3:03 p.m. until 3:40 p.m., the LPAs reviewed and obtained copies of documents pertinent to the investigation.
Regarding the allegation, ‘Facility staff do not have background clearance’, the complainant’s concerns is that the facility is hiring staff without background clearance prior to employment.

Continue on LIC 9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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-20211123163312

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: COMFORT ELDERLY CARE	FACILITY NUMBER: 195850162
	VISIT DATE: 12/02/2021

NARRATIVE

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During today’s visit, the LPAs conducted record review, interviews with facility residents and staff. Interviews revealed that staff #1 (S1), and staff #2 (S2) are the current staff working at the above facility. Record review revealed, that S1 and S2 are associated to the facility.
Based on observation by the LPA, record review, interviews conducted with staff, and residents there is insufficient evidence to conclude this allegation. Therefore, this allegation is deemed Unsubstantiated at this time.
Regarding the allegation, ‘Facility does not provide laundry service,’ the complainant’s concerns is that the facility does not provide sufficient supplies for washing resident’s clothes on a regular basis.
During today’s visit, the LPAs conducted interviews with facility residents and staff, and conducted a physical plant tour. Interviews revealed that S1, and S2 provide residents with laundry services every day.
Based on observation by the LPAs the facility has adequate stocked laundry supplies to efficiently provide laundry services on a daily basis. Therefore, there is insufficient evidence to conclude this allegation and it is deemed Unsubstantiated at this time.
Regarding the allegation, ‘Facility is dirty,’ the complainant’s concern is that the facility staff never clean resident bedrooms, and that there is urine in residents bedroom floors.
During today’s visit, the LPAs conducted interviews with facility residents and staff, and conducted a physical plant tour. Interviews revealed that S1, and S2 clean the facility every day at least once a day.
Based on observation by the LPAs the facility was clean at the time of visit. The LPAs did not observe any urine in four (4) out of four (4) resident rooms. Therefore, there is insufficient evidence to conclude this allegation and it is deemed Unsubstantiated at this time.

Exit interview conducted, a copy of report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

LIC9099 (FAS) - (06/04)

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