195850173-5-31-2024-29-AS-KHEN-D5T2A4-20240531171255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850173
Report Date: 05/31/2024
Date Signed: 05/31/2024 04:18:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
08/31/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20230831170852

FACILITY NAME:	A'MORECARE HOME ASSISTED LIVING		FACILITY NUMBER:	195850173
ADMINISTRATOR:	ANNETTE AMIRKHANIAN		FACILITY TYPE:	740
ADDRESS:	23511 BERDON STREET		TELEPHONE:	(818) 704-0012
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	0	CENSUS: 0	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	03:43 PM
MET WITH:	Sean Madadian, Licensee / Annette Amirkhanian, Administrator		TIME COMPLETED:	04:18 PM

ALLEGATION(S):

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Staff Neglect led to Resident's Death
Resident sustained unexplained injuries while in care.
Staff do not ensure residents’ needs are met.
Staff do not ensure that residents are adequately fed.
Staff mismanage resident medications.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced telephonic subsequent complaint visit at the facility today to deliver findings. At 3:50 p.m., the LPA called the Administrator and explained the reason for the phone call. At 3:54 p.m., LPA Peraldi called the Licensee and explained the reason for the phone call.
During the initial visit on 9/01/2023, between 9:40 a.m. and 1:30 p.m., LPA Martha Arroyo interviewed the Co administrator Licensee, Sean Madadian, two (2) staff and one (1) family member. The LPA also conducted a file review at 11:15 a.m. and obtained copies of pertinent documents. On 04/18/2024, LPA Peraldi conducted a subsequent visit between 9:30 a.m. and 4:10 p.m. During the subsequent visit, LPA Peraldi conducted interviews with two (2) resident, one (1) staff and one (1) resident’s family member. On 05/31/2024, LPA Peraldi conducted a telephonic interview with Resident #1’s (R1’s) hospice agency.
Continued LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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-20230831170852

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: A'MORECARE HOME ASSISTED LIVING	FACILITY NUMBER: 195850173
	VISIT DATE: 05/31/2024

NARRATIVE

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Regarding the allegation: Staff Neglect led to Resident's Death. On 08/31/2023, the Department received a complaint alleging that staff neglect led to Resident #1’s (R1’s) and Resident #2’s (R2’s) death. During the initial visit, LPA Arroyo conducted a file review, however the facility did not have completed resident records. Resident #1’s (R1’s) death report, dated 08/30/2023 and filled out by the Administrator, stated that R1 passed away on 8/28/2023 due to cancer complications. R1 was on hospice services during the time of death. On 05/31/2024, LPA Peraldi called R1’s hospice agency and confirmed that R1’s death was due to cancer complications and not due to suspicious circumstances. Resident #2’s (R2’s) death report, dated 06/12/2023 and filled out by the Administrator, stated that R2 passed away on 6/12/2023 due complications following long time dementia. R2 was also receiving hospice services during time of death, however the LPA could not obtain the hospice agency information. The information obtained during the investigation did not include evidence sufficient 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 deemed Unsubstantiated at this time.

Regarding the allegation: Resident sustained unexplained injuries while in care. Staff do not ensure residents’ needs are met. Staff mismanage resident medications. On 08/31/2023, the Department received a complaint alleging that staff would not meet residents needs as they were always sleeping. The complainant also alleged that staff mismanaged medications and that R1 had bruises and skin tears on arms. During the initial visit, LPA Arroyo conducted a file review however the facility did not have completed resident records or facility records. No additional information was available during the time of the visit. From August 2023 to January 2024, the facility went through a change of ownership and a change of staff, making it difficult to obtain information. Interview with a resident’s family member during the initial visit did not reveal any concerns regarding care of resident. Interviews with residents during the subsequent visit did not reveal any issues with current staff. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Continued on LIC 9099-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230831170852

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: A'MORECARE HOME ASSISTED LIVING	FACILITY NUMBER: 195850173
	VISIT DATE: 05/31/2024

NARRATIVE

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Regarding the allegation: Staff do not ensure that residents are adequately fed. On 08/31/2023, the Department received a complaint alleging that staff would refuse to feed residents. During the initial visit, the Administrator provided copies of receipts of groceries. Interview with a resident’s family member during the initial visit did not reveal any concerns regarding food service. Interviews with resident during the subsequent visit revealed that residents are satisfied with the food being served. The information obtained during the investigation did not include evidence sufficient 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 deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was issued to the former licensee via mail for signature.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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