195850239-6-2-2023-29-AS-JAPL-CSQPVQ-20230612113928

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850239
Report Date: 06/02/2023
Date Signed: 06/02/2023 02:47:33 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
01/20/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230120100613

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):

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Resident Abandonment

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Sandra Urena conducted an unannounced subsequent visit to deliver the findings for the allegation listed above. LPA Urena arrived at the facility at 10:05 a.m. LPA Urena met with the Administrator Elba Khachatryan and explained the reason for the visit.

On 01/26/2023, Licensing Program Analyst (LPA), Sandra Urena conducted an unannounced initial visit to investigate the allegation listed above. LPA Urena arrived at the facility at 11:02 a.m. LPA Urena met with Administrator and explained the reason for the visit. The LPA conducted staff interviews from 12:02 p.m. to 1:00 p.m. The LPA needs to conduct further investigation prior to delivering the findings.

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)

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Control Number 29-AS-20230120100613

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

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On the allegation of ‘Resident Abandonment’, it is the complainant’s concern that facility staff abandoned R1 outside the facility; consequently, R1 was found wandering alone in the streets. To investigate this allegation, LPA Urena interviewed the complainant, administrator, and R1’s POA. The complainant’s interview revealed that the information they provided, was information they received by the hospital’s emergency caseworker, and that the caseworker stated the following, “The administrator said that they were the ones one who left R1 sitting in their wheelchair outside the facility”. The LPA interviewed the facility’s administrator about leaving R1 outside the facility, and they denied leaving R1 outside the facility sitting on the chair. Furthermore, the administrator stated that the administrator’s relative took R1 to the hospital’s emergency room (ER), because R1 became extremely agitated, and aggressive towards staff, and refused to be changed out of soiled diapers and clothing. The administrator's relative took R1 to the hospital’s ER entrance and ‘left’ R1 with the attending hospital staff. The LPA spoke with R1’s POA on 01/26/2023 and asked them if they were informed about R1 being taken to the hospital. The POA stated that they were not aware that R1 had been taken to the board and care facility in the first place. The POA added that they live out of California, and that they found out that R1 was at the hospital when law enforcement called them to inform them that R1 was at the hospital. According to the POA, they thought that R1 was still at the rehabilitation center in Rancho Cucamonga. Law enforcement informed the POA that they had received a call for a missing individual(R1), and that they were reporting to them that they had found R1.

Although the allegation may have happened or is valid, there is not sufficient evidence to support the allegation that the facility staff abandoned R1 outside the facility; and R1 was found wandering alone in the streets. Therefore, the allegation is deemed Unsubstantiated at this time.

Citations were not issued. Exit interview was conducted. 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)

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