195850239-8-11-2023-29-AS-KLOZ-CWNV2F-20231016160301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850239
Report Date: 08/10/2023
Date Signed: 08/11/2023 08:35:34 AM

Substantiated

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
06/12/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230612152257

FACILITY NAME:	SILVER LIGHT CARE		FACILITY NUMBER:	195850239
ADMINISTRATOR:	KHACHATRYAN, ELBA		FACILITY TYPE:	740
ADDRESS:	8201 VANTAGE AVENUE		TELEPHONE:	(747) 228-4111
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 3	DATE:	08/10/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Elba Khachatryan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not allow Ombudsman right to access and look at a resident's records.
Facility staff is recording all conversations in facility.

INVESTIGATION FINDINGS:

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On 08/10/2023, Licensing Program Analysts (LPAs) Sandra Urena, and Angel Ascencio conducted an unannounced visit to deliver the findings for the allegations listed above. The LPAs were greeted by staff, and staff called the administrator via phone. The administrator stated that they were far away from the facility and would be available in approximately in 1.5 hours. The LPAs agreed to come back. LPAs met with Elba Khachatryan, and explained the reason for the visit.

On 06/19/2023, Licensing Program Analyst (LPA), Sandra Urena conducted an unannounced visit to investigate the allegation listed above. LPA met with Administrator Elba Khachatryan, and explained the reason for the visit. At 11:40 a.m. The LPA met with the administrator in the patio area to conduct an interview. The LPA requested records for review at 12:15 p.m.

Conitnues on LIC 9099 C...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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-20230612152257

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: SILVER LIGHT CARE	FACILITY NUMBER: 195850239
	VISIT DATE: 08/10/2023

NARRATIVE

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Facility staff did not allow Ombudsman right to access and look at a resident's records.
On the allegation that the ‘Facility staff did not allow the Ombudsman right to access and look at a resident's records’; it is the complainant’s concern that the Ombudsman were not allowed to review R1 records. To investigate the allegation, the LPA interviewed R1, the Ombudsman and the administrator. Per the R1’s interview, they gave written permission to the Ombudsman to review their resident’s records. Per the interview with the Ombudsman, the interview revealed that on 06/09/2023, they received permission from R1 via the State of California-Consent to Access and Disclose Confidential Form (OSLTCO S201). The administrator stated that they were informed by their consultant that they did not have to release the information to the Ombudsman, consequently the administrator did not allow the Ombudsman access to R1’s facility records.

Based on the information and record review obtained, there is sufficient evidence to support the allegation that the Facility staff did not allow Ombudsman the right to access and look at R1’s records. Therefore, the allegation is deemed to be Substantiated at this time.

Facility staff is recording all conversations in facility.
On the allegation that the Facility staff is recording all conversations in facility, it is the complainant’s concern that the administrator stated that "all conversations in facility are being recorded". The LPA investigated the allegation by interviewing the complainant who stated that the Ombudsman was told by the administrator that the conversations were being recorded at the facility. The Ombudsman interview revealed that the administrator said to them during the course of a visit that “all conversations in facility are being recorded”. The LPA could not find visible recording devices; however, the LPA did observe staff recording them with their private phones during a visit that was conducted on 06/19/2023.

Based on the information obtained, the preponderance of evidence supports the allegation that the Facility staff is recording conversations in facility. Therefore, the allegation is deemed Substantiated at this time. This allegation was cited during a Case Management Visit on 06/21/2023.
Pursuant to Title 22, California Code of Regulations (CCR), the following deficiency is cited (refer to LIC 9099-D).
Exit interview was conducted. A copy of the report and Appeal Rights were issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230612152257

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: SILVER LIGHT CARE	FACILITY NUMBER: 195850239
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/10/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/18/2023 Section Cited CCR 87468.2(a)(2)	1 2 3 4 5 6 7	Additional Personal Rights of(a)In addition to the rights listed in Section87468.1 ... the elderly shall have all of the following personal rights: (2) To have their records and personal information...and approve their release, except as authorized by law. (19) To have prompt access to review all of their records and to …This requirement is not met as.	1 2 3 4 5 6 7	Administrator will submit a Statement of Understanding detailing the importance of Regulation 87468.2(a)(2) and submit by 8/18/2023.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not meet the section cited above as they failed to produce records requested by a State representative, which poses a potential risk to the personal rights of residents in care.	8 9 10 11 12 13 14
Type B 08/18/2023 Section Cited ILS 87468.2(a)(1)	1 2 3 4 5 6 7	Additional Personal Rights of ... (a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities ...shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in communications... This requirement is not met as.	1 2 3 4 5 6 7	Administrator was cited for this violation during a case management visit on 06/21/2023 and was cleared on 07/19/2023.
	8 9 10 11 12 13 14	Based on observation, the administrator and S1 did not comply with the section cited above by stating admitted use of recording devices, which poses an immediate health and safety risk to persons in care.	8 9 10 11 12 13 14

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: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

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