195850163-3-28-2023-29-AS-DPEA-CQETBT-20230330143539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850163
Report Date: 03/28/2023
Date Signed: 03/28/2023 02:07:40 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
11/24/2021 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20211124110542

FACILITY NAME:	BELLAIRE SENIOR CARE, LLC		FACILITY NUMBER:	195850163
ADMINISTRATOR:	KHAMBEKYAN, SANDY		FACILITY TYPE:	740
ADDRESS:	6523 BALLAIRE AVE		TELEPHONE:	(818) 856-6980
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 5	DATE:	03/28/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ovsanna Khayalyan, Facility Manager & Venera Nestterova, Staff		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff does not meet resident's hygiene needs.
Residents sustained pressure injuries while in care.
Insufficient staffing not meeting resident's needs.

INVESTIGATION FINDINGS:

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A subsequent complaint visit was conducted today for the above allegations. Licensing Program Analyst (LPA) was initially greeted by staff Venera Nestterova, and later met with facility manager Ovsanna Khayalyan at approximately 11AM. Reason for the visit was explained.
Following is a summary of the investigation summary:

On 11/24/2021, An anonymous complaint was received regarding resident (R1) developing two (2) bed sores on buttocks area while in care of this facility; R1 not assisted in showering/bathing; not been assisted in brushing teeth since moving in. Also, it was reported that staff on duty is not physically able to transfer the resident out of bed.

Initial complaint visit was conducted on On 12/1/2021 by LPA Saila Walker - A physical plant tour was conducted from 12:10 PM. to 12:27 PM.; the LPA conducted interviews with five (5) out six (6) residents from 12:32 PM. to 1:04 PM.; and interviews with two (2) staff from 1:20 PM. to 1:42 PM. (cont. to LIC9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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-20211124110542

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: BELLAIRE SENIOR CARE, LLC	FACILITY NUMBER: 195850163
	VISIT DATE: 03/28/2023

NARRATIVE

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Between 1:47 PM. to 2:00 PM., the LPA conducted an interview with the administrator Sandy Khambekyan. From 2:00 PM. to 3:00 PM., the LPA reviewed and obtained copies of records pertinent to the investigation. Resident interviews revealed hygiene needs are being met; no issues or concern with staffing and no pressure injuries reported. One resident (R1) interviewed reported not liking the facility and refuse services. R1 observed very agitated, aggressive and uncooperative with staff. R1 was eventually sent to the hospital on 12/1/2021 and has not returned since. Records reviewed on 12/1/2021 by LPA Walker did not reveal any resident with wounds. Staff and former Administrator Sandy Khambekyan interviewed confirmed that residents in care did not have any wounds.

LPA Chochian conducted a subsequent complaint visit today on 3/28/2023 to conclude investigation and deliver investigation finding. LPA conducted a physical plant tour today at approximately 10AM with staff and observed five (5) residents. Interview was conducted with three (3) residents at approximately 10:15AM to 10:45AM. Residents interviewed did not report any issues or concerns with staff not meeting their hygiene needs. Residents reported staff are meeting their care needs. Residents denied having any wounds. LPA conducted interview with two potential witnesses at approximately 10:45AM-11AM. These witnesses did not report any concern with residents care needs being met; no staffing issue and no current resident with any pressure injuries. Interview with staff and house manager from approximately 11:15AM-12PM revealed that former resident (R1) was at the facility for less than a month; staff recalled R1 and stated that R1 did not have any skin condition while in care at this facility. Staff reported that R1 was very aggressive and combative with staff. According to staff R1 was receiving showers and was changed three (3) to four (4) times a day. Staff reported that R1 was bedridden but able to reposition self and assist when changing. R1 was hospitalized on 12/1/2021 and did not return to the facility.

Based on the information obtained, there is insufficient evidence to support the allegations. Therefore allegations, Staff does not meet resident's hygiene needs; Residents sustained pressure injuries while in care and Insufficient staffing not meeting resident's needs are deemed Unsubstantiated at this time.

Exit interview conducted and copy of report provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

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