195850176-11-18-2024-29-AS-KHEN-DBESYL-20241127131743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850176
Report Date: 11/18/2024
Date Signed: 11/18/2024 05:27:49 PM

Substantiated

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
11/13/2024 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20241113140220

FACILITY NAME:	NOHO ASSISTED LIVING, INC		FACILITY NUMBER:	195850176
ADMINISTRATOR:	ARPINE MKRTCHYAN		FACILITY TYPE:	740
ADDRESS:	6331 SIMPSON AVE		TELEPHONE:	(818) 404-0550
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 4	DATE:	11/18/2024
		UNANNOUNCED	TIME BEGAN:	11:19 AM
MET WITH:	Arpine Mkrtchyan		TIME COMPLETED:	05:35 PM

ALLEGATION(S):

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Facility staff did not seek timely medical attention for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and was let into the home by Anahit Anatomyan, Staff. Arpine Mkrtchyan, Administrator was contacted by staff to advise her that Licensing was at the facility and she arrived at 11:44 am to conduct the visit. The reason for today's visit was explained.

On today's visit, LPA Yee conducted an interview with the Administrator at 11:47am and staff #1 at 1:38pm and reviewed and obtained available facility files at 12:33pm. Additional files will be emailed to LPA Yee later today.

Per information received from interviews conducted, on 11/12/24, Resident #1 was given breakfast around 9am and lunch around 12:30pm and resident ate very little food and was not hungry. Resident #1 is known

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

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-20241113140220

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: NOHO ASSISTED LIVING, INC	FACILITY NUMBER: 195850176
	VISIT DATE: 11/18/2024

NARRATIVE

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for their hearty appetite. After lunch, Resident #1 was changed by caregiver and they were observed breathing heavily despite being on oxygen and the Administrator was advised. The Administrator notified the family that the resident did not have an appetite and also contacted Resident #1's doctor around 1 or 1:15pm to notify the doctor about Resident #1's heavy breathing. Per the doctor's instructions, the Administrator was told to increase Resident's oxygen level from 2 liters per minute to 4 liters per minute. Resident continued to have difficulty breathing even after increasing the oxygen level. Emergency services was not contacted until later in the afternoon when the resident's ability to breath became rapidly more difficult. The Administrator was guided by 911 personnel to perform cardiopulmonary resuscitation until the paramedics arrived at the facility to take over. Per the Administrator, this is the first time that she encountered a situation like this and she thought she was doing the right thing by contacting the resident's doctor for instructions and notifying the family, instead of calling 911 immediately.

Based on the information received from the interviews conducted, there is sufficient evidence to support the allegation that facility staff did not seek timely medical attention for resident. Therefore, the allegation is substantiated at this time.

Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8

Exit interview was conducted, Appeals Rights discussed and a copy was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241113140220

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: NOHO ASSISTED LIVING, INC	FACILITY NUMBER: 195850176
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/19/2024 Section Cited CCR 87465(g)	1 2 3 4 5 6 7	Incidental Medical and Dental Care: The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4).	1 2 3 4 5 6 7	Licensee will review their emergency protocol and draft a written plan of action that will be implemented to ensure that all residents are provided with immediate emergency services by 11/19/24 Licensee will also provide staff with personal rights training and submit evidence of training by 11/25/24.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Resident #1 was observed having difficulty breathing before lunch and the staff did not call 911 services until the late afternoon when the resident's ability to breathe rapidly declined.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024

LIC9099 (FAS) - (06/04)

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