195850239-7-20-2023-29-AS-SURA-CTWTCV-20230720143723

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850239
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:38:39 PM

Document Has Been Signed on 07/20/2023 02:38 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 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:	DATE:	07/20/2023
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Elba Khachatryan		TIME COMPLETED:	01:37 PM

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	An Informal Conference was conducted today in the Woodland Hills North Adult and Senior Care Regional Office via Teams. The purpose of this Informal Conference is to discuss incidents that took place on 06/19/2023 during the investigation of Complaint Control # 29-AS-20230609085812 and Complaint Control #29-AS-20230612152257, which resulted in deficiencies cited in a case management- deficiencies report dated 06/21/2023. Present at today's meeting included the licensee (Silver Light, Inc), representative/administrator, Elba Kachatryan, Consultant for Silver Light, Inc., Tamme Madden, Licensing Program Manager (LPM) Jeralyn Pfannenstiel and Licensing Program Analyst (LPA) Sandra Urena. The informal conference process was explained to the Licensee representative/Administrator. The Licensee representative/Administrator was also informed that this Informal Conference is a part of the administrative action process and that further citations may result in a Non-Compliance Conference, which could lead to a compliance plan or a referral for Administrative Review by the Department’s Legal Division for possible Administrative Action. LPM Pfannenstiel discussed deficiencies cited during the case management-deficiency, which included Inimical Conduct towards the LPA, violation of the Personal Rights of Resident #1, by means of intimidation, and verbal harassment, and violation of Personal Rights of Resident #1 by not providing a reasonable level of personal privacy in communications, and telephone conversations. In addition, the LPM discussed the administrator’s responsibilities regarding maintaining control of her staff. If staff #1, Edgar Khachatryan, is using the “F word” towards the LPA, what is he saying to the residents when others are not present? Why was he allowed to interrogate a resident? Continues on LIC 809C...

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: 07/20/2023

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

The Licensee representative/administrator and the consultant, Tamme Madden, understood and concerns and confirmed that from this day forward, the LPAs would be treated with respect. Although the licensee/administrator disagreed that any resident was interrogated or disrespected, it was confirmed that all residents would also receive the respect due to them.

At this time, the licensee representative/administrator has cleared the Plan of Corrections as of 07/19/2023. An appeal was sent to the Department; however, during today’s informal conference, the licensee requested to withdraw/dismiss the appeal. The licensee stated that their consultant read the appeal and recommended that the licensee withdraw and/or dismiss the appeal.

Exit interview conducted. A copy of the report was issued via email. The licensee agreed to print and sign a copy of the report, and email the report back to the LPA.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2