195850239-6-2-2023-29-AS-JAPL-CSQQUJ-20230612122850

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850239
Report Date: 06/02/2023
Date Signed: 06/02/2023 02:45:31 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
03/03/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230303110152

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:	06/02/2023
		UNANNOUNCED	TIME BEGAN:	10:09 AM
MET WITH:	Elba Khachatryan		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are refusing to let resident out of bed.
Staff are not providing a safe environment for resident.
Staff are not providing resident with privacy.
Staff did not prevent the bathroom from smelling.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to investigate the allegations listed above. The LPA arrived at the facility at 10:09 a.m. The LPA met with the Administrator Elba Khachatryan and explained the reason for the visit.

On 03/09/2023, Licensing Program Analyst (LPA), Sandra Urena conducted an unannounced initial visit to investigate the allegations listed above. The LPA arrived at the facility at 12:50 p.m. and was greeted by staff. Staff contacted the Administrator to inform them of the visit. The LPA met with the Administrator Elba Khachatryan at 1:45 p.m. and explained the reason for the visit.

Continues on LIC 9099C…

Unsubstantiated

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: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20230303110152

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: 06/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 2. Staff are refusing to let resident out of bed.On the allegation that ‘Staff are refusing to let resident out of bed’; the complainant’s concern is that staff are preventing R1 get out of bed, to control R1’s movements. To investigate the allegation the LPA interviewed R1. R1 stated that they cannot walk or get out of bed because of the recent surgery. R1 stated that they have an excellent nurse that helps them with exercises. Furthermore, when the LPA asked if R1 has been prevented them from getting out of bed R1 replied, “No, but I have tried”.

Based on the information obtained, there is not sufficient evidence to support the allegation that Staff are refusing to let resident out of bed. Therefore, the allegation is Unsubstantiated at this time.

Staff are not providing a safe environment for resident.

On the allegation that ‘Staff are not providing a safe environment for resident’; the complainant’s concern is that R1 is scared, doesn’t feel safe and said that R1 feels like a hostage. To investigate the allegation, the LPA interviewed R1 in private. When the LPA asked R1 if they felt afraid of staff or being at the facility, R1 replied, “No, they are good friends”. The LPA interviewed residents about their environment, and the residents stated, “I’m ok” and “Everything is fine”.

Based on the information obtained, there is not sufficient evidence to support the allegation that Staff are not providing a safe environment for resident. Therefore, the allegation is Unsubstantiated at this time.

Staff are not providing resident with privacy.

On the allegation that ‘Staff are not providing resident with privacy’; the complainant’s concern is that the administrator is monitoring R1’s phone calls by checking the times R1 receives calls, and how many times the POA calls R1. In addition to monitoring the calls, the complainant stated that staff would listen to the calls between R1 and the POA. To investigate the allegation, the LPA interviewed R1. R1 stated that they can talk on the phone but needs assistance with dialing because they sometimes cannot get the calls to go through. R1 had a private room at the time of the interview. The LPA interviewed residents about being provided privacy by staff. The residents stated that they get privacy when they speak with their relatives.

Based on the information obtained, and although the allegation may have happened or is valid, there is not sufficient evidence to support the allegation that Staff are not providing resident with privacy. Therefore, the allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20230303110152

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: 06/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 3.

Staff did not prevent the bathroom from smelling.
On the allegation that ‘Staff did not prevent the bathroom from smelling’; the complainant’s concern is that R1 stated that the bathroom has a smell. To investigate the allegation, on 01/26/2023 the LPA conducted a physical plant inspection of the facility at 12:59 p.m. During the inspection, the LPA observed the bathroom to be in clean condition, and void of any odors. Hand washing sign was visible, soap and paper towels were available. The bathroom is located between bedroom #2 and bedroom # 3. R1 is non-ambulatory and was unable to ambulate to the bathroom due to recent surgery. The LPA interviewed residents, and the residents stated that they were not aware of any odor or smells in the bathroom. The LPA interviewed R1 about the smell in the bathroom, R1 stated, “I can’t walk and I have to wear diapers”.

Based on observation and the information obtained, there is not sufficient evidence to support the allegation that Staff did not prevent the bathroom from smelling. Therefore, the allegation is Unsubstantiated at this time.

No citations were issue. Exit interview was conducted with the Administrator. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3