195850239-7-1-2024-29-AS-KHEN-D7FN9V-20240723101635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850239
Report Date: 07/01/2024
Date Signed: 07/01/2024 12:28:36 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
06/26/2024 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20240626155102

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: 4	DATE:	07/01/2024
		UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Elba Khachatryan, and Keyna Nkumbula staff		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Facility staff hit resident
Facility staff lock resident in their room

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 9:28 a.m., the LPA met with staff and explained the reason for the visit. At 9:49 a.m., the Administrator Elba Khachatryan arrived at the facility. During the time of the visit, the Administrator left and authorized staff, Keyna Nkumbula, to sign the report.

Between 9:30 a.m. and 12:10 p.m., the LPA conducted interviews with four (4) residents and one (1) staff. At 9:40 a.m., the LPA conducted a physical plant tour. At 9:51 a.m., the LPA conducted an interview with the Administrator. At 10:06 a.m., the LPA requested and obtained copies of pertinent documents. At 11:22 a.m., the LPA conducted a telephonic interview with a resident’s family member.

Continued on 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: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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-20240626155102

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: SILVER LIGHT CARE	FACILITY NUMBER: 195850239
	VISIT DATE: 07/01/2024

NARRATIVE

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Regarding the allegation: Facility staff hit resident. On 06/26/2024, the Department received a complaint alleging that facility staff hit Resident #1 (R1). No further information was provided from the complainant including names of staff. During the initial visit, the LPA conducted interviews with four (4) out of four (4) residents. Resident interviews denied staff hitting residents. The interviews revealed that the residents feel safe at the facility. No safety concerns were brought up during the resident interviews. Staff #1 (S1) denied hitting R1. S1 stated that they have not witness other staff hit R1 or other residents in care. The Administrator indicated that they had not witnessed staff hit or mistreat residents, including R1. Additionally, the LPA had a telephonic interview with R1’s family member; R1’s family member did not reveal any concerns regarding staff. 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: Facility staff lock resident in their room. On 06/26/2024, the Department received a complaint alleging that facility staff lock Resident #1 (R1) in their room. No further information was provided from the complainant. Resident interviews revealed that staff do not lock them in their rooms. Residents stated that the door handles do not have locks. No safety concerns were brought up during the resident interviews. Administrator and Staff interviews revealed that the resident rooms do not lock and that only the front and back doors remain locked for safety reasons. The LPA observed resident rooms doors open during the time of the visit and did not observe locks on resident door handles. 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.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

LIC9099 (FAS) - (06/04)

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