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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850239
Report Date: 06/21/2023
Date Signed: 06/21/2023 12:03:12 PM


Document Has Been Signed on 06/21/2023 12:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:SILVER LIGHT CAREFACILITY NUMBER:
195850239
ADMINISTRATOR:KHACHATRYAN, ELBAFACILITY TYPE:
740
ADDRESS:8201 VANTAGE AVENUETELEPHONE:
(747) 228-4111
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:6CENSUS: 3DATE:
06/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Elba Khachatryan TIME COMPLETED:
12:00 PM
NARRATIVE
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On 06/21/2023 at 09:30 a.m., Licensing Program Analysts (LPAs) Sandra Urena, and Teresa Camara conducted an unannounced Case Management-Deficiency visit, due to two incidents that took place during the investigation of Complaint Control # 29-AS-20230609085812 and Complaint Control #29-AS-20230612152257 on 06/19/2023. The LPAs met with Administrator Elba Khachatryan and explained the reason for the visit.

On 06/19/2023, during the course of the investigation of the complaints listed above, the administrator and Staff #1 (S1) engaged in an Inimical Conduct towards the LPA. At approximately 12:20 p.m., the LPA was sitting at the dining room table in the common area writing the LIC 9099 complaint reports, when the administrator said to the LPA in a demanding voice, “Stop what you are doing and answer a question. Why did you conduct the interview in Spanish?” (The administrator was referring to the interview of Resident #1 (R1), which the LPA conducted in the privacy of their bedroom with the door closed. How did the administrator even know the interview was in Spanish unless they were eavesdropping?). The LPA replied to the administrator that the interview can be done in whichever language the resident speaks. The administrator stated that the resident spoke English too, and once again questioned the LPA about why the interview was done in Spanish? The LPA repeated that the interview can be conducted as best to communicate in private with the resident.

While the LPA was still speaking with the administrator, S1 stood by the dining room table and interjected themselves into the conversation and addressed the LPA in a disrespectful manner while using a loud voice. The LPA stated to S1 that their tone of voice was unprofessional and disrespectful; to which S1 stated the following: ‘Everything is being recorded’ (at this time the administrator motioned to the caregiver with their hand to be quiet). S1 ignored the motion by the administrator and yelled the following to the LPA; “‘Who the f--k do you think you are? ‘I told you to speak English’. ‘You are a racist’. ‘You get paid by me’.” The LPA tried to speak, and S1 yelled, “I don’t give a f--k what you say, you are losing your job (laugh).” S1 later repeated to the LPA ‘you are losing your job’ while laughing

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/21/2023
NARRATIVE
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On 06/19/2023, at approximately 12:25 p.m., during the course of the investigation of the complaints listed above, the administrator and Staff #1 (S1) then engaged in conduct which violated the Personal Rights of Resident #1 (R1). S1 removed R1 from their room and sat them down with the LPA at the dining room table. The administrator and S1 interrogated R1 in front of the LPA about a private, and confidential conversation held between the LPA and R1 in the privacy of R1’s bedroom with the door closed. In an excessive and intimidating loud voice and manner, S1 and the administrator questioned the resident by yelling at them: ‘Tell me what the LPA told you’. R1 seemed confused and said, ‘What did the LPA say, I don’t remember’. S1 then said to the resident, ‘You told me that the LPA told you to speak Spanish, why’? R1 seemed confused, and said, ‘I don’t know’. The administrator and S1 continued to badger the resident about the reason for the interview in Spanish. R1 appeared frightened by the tone of voice of S1 and the administrator. The LPA placed a hand on R1’s shoulder and leg to try to calm them down, to which S1 reacted by yelling to the LPA to stop touching R1.

The conversation between R1 and the LPA was conducted in Spanish to keep the conversation private and secure, based on two complaints that have been received alleging staff/administrator failed to provide residents privacy with visitors or while on the phone.

Pursuant to Title 22 of the CA Code of Regulations, and the Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D).



Exit interview conducted, citations were read. Administrator refuse to sign report at 11:59 am. Today's report appeal rights were reviewed and issued to the administrator
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/21/2023 12:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/23/2023
Section Cited
CCR
87468.1(a)(1)(2)

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Personal Rights of Residents in All Facilities (a)Residents in all residential care facilities... shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff...2) To be free from...humiliation, intimidation...This requirement is not met as.
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The Administrator will review and train staff on Residents Personal Rights and submit proof to CCLD Office by 06/23/2023.
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Based on observation, the administrator and S1 did not comply with the sections cited above by intimidating, frightening and humiliating R1 by yelling at them in an aggressive loud tone combined with angry facial expressions, which poses an immediate health and safety risk to persons in care.
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Type A
06/23/2023
Section Cited
CCR87468.2 (a)(1)

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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, telephone conversations... This requirement is not met as.

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The Administrator will review and train staff on Residents Personal Rights and submit proof to CCLD Office by 06/23/2023.
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Based on observation, the administrator and S1 did not comply with the section cited above by eavesdropping on private conversations by admitted use of recording devices, which poses an immediate health and safety risk to persons in care.
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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 PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 06/21/2023 12:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/23/2023
Section Cited
CCR
87405(d)(1)(2)(4)(5)

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Administrator – Qualifications and Duties
The administrator shall have…(1) Knowledge of the requirements for providing care...(2) Knowledge of and ability to confirm to the applicable laws, rules and regulations; (4)…ability to direct the work of others; (5) Good character and a continuing reputation of personal integrity. The requirement was not met as
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The Administrator will review and train staff on Reg. 87405(d)(1)(2)(4)(5) and submit proof to CCLD Office by 06/23/2023.
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Based on observation, the administrator did not comply with the section cited above by failing to keep S1 from verbally abusing R1 and the LPA, in addition to verbally abusing R1 themselves, which poses and immediate health and safety risk to persons in care.
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Type A
06/23/2023
Section Cited
HSC1569.58(2)

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HSC-1569.58(2) Inimical Conduct
Inimical Conduct (2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or to the people of the State of California. This requirement is not met as.
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The Administrator will review and train staff on Reg. HSC- 1569.58(2) and submit proof to CCLD Office by 06/23/2023.
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Based on observation, S1 did not comply with the section cited above by attempting to intimidate, yelling at and using vulgar/swear words when speaking to the LPA, which poses an immediate health and safety risk to the people of the State of California.
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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 PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
LIC809 (FAS) - (06/04)
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