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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850239
Report Date: 10/22/2024
Date Signed: 10/22/2024 04:48:52 PM

Substantiated


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
10/17/2024 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20241017091640
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: 5DATE:
10/22/2024
UNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:Elba KhachatryanTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not secure knives/sharp objects making them accessible to residents
Staff locked refrigerator
House rules violate residents personal rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 01:47 PM. LPA met with the facility staff who contacted the facility administrator Elba Khachatryan via telephone call. The administrator arrived to the facility at 02:30 PM, the reason for the visit was explained, and entrance interview was conducted.

During today’s visit LPA conducted a physical plant tour, interviewed residents, interviewed facility staff, and interviewed the facility administrator between 01:50 PM and 02:28 PM.

Continued on LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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 4
Control Number 29-AS-20241017091640
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/22/2024
Section Cited
CCR
87309(a)
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87309 Storage Space
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
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Licensee repaired the locking mechanism at the time of the visit POC cleared.
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Based on observation and interview the licensee failed to comply with the section cited above as the locking mechanism on the drawer containing knives and other sharp objects was broken making the items accesable which poses an immediate safety risk to clients in care.
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Type B
11/05/2024
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents in...care facilities for the elderly shall have...rights:
(2) To be accorded... comfortable accommodations, furnishings and equipment.
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The lock on the fridge was removed at the time of the visit. Licensee will submit ann updated list of house rules to CCLD no later than POC due date.
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Based on observation and interview the licensee failed to comply with the section cited above as Some house rules violate personal rights and the fridge was locked to clients in care which poses a potential personal rights risk to clients 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.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 29-AS-20241017091640
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: 10/22/2024
NARRATIVE
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The allegation of “Staff did not secure knives/sharp objects making them accessible to residents” alleges that facility staff do not properly secure knives and other sharp objects from clients in care. During the physical plant tour LPA Byrne asked facility Staff #1 (S1) where knives are stored in the kitchen. S1 directed LPA to a drawer where knives, scissors, and other utensils were stored. At 02:05 PM LPA observed a locking mechanism on the drawer that was broken and failed to properly secure the drawer. LPA interviewed Administrator and S1 and asked when they noticed the drawer lock was broken. Both the Administrator and S1 stated that they did not notice until today (10/22/2024). During the visit facility staff replaced the locking mechanism. LPA confirmed that the drawer now properly latches making its contents inaccessible to clients in care. Based on the information obtained during the physical plant tour and interviews there is sufficient evidence to support the allegation of Staff did not secure knives/sharp objects making them accessible to residents. Therefore, the allegation is deemed Substantiated at this time.

The allegation of “Staff locked refrigerator” alleges that facility staff secure the contents of the facility’s refrigerator making its contents unavailable to clients in care. During the physical plant tour LPA observed the facility refrigerator to contain a child proofing device on the left side. S1 opened the refrigerator and LPA observed foods, drinks, condiments, and snacks inside. LPA interviewed Administrator and S1 and asked the reasoning for the refrigerator being secured. S1 did not know the reason for the fridge being secured. The Administrator stated that the facility had a resident in the past that would enter the kitchen and try to cook, although the Administrator confirmed that the resident no longer resides at the facility and there is no current reason to keep the refrigerator secured. The Administrator agreed to remove the lock from the side of the refrigerator. Based on the information obtained during the physical plant tour and interviews there is sufficient evidence to support the allegation of Staff locked refrigerator. Therefore, the allegation is deemed Substantiated at this time.

Continued on LIC 9099C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20241017091640
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: 10/22/2024
NARRATIVE
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The allegation of “House rules violate residents personal rights” alleges that the house rules of the facility are a violation of the resident’s personal rights. During the physical plant tour LPA observed the house rules posted in the living room of the facility. LPA reviewed the facility’s house rules and observed some that are violations of resident’s rights. LPA observed the house rules to contain the following lines: “To cooperate with all staff and take medication assigned by doctor on schedule unless otherwise instructed by the assigned doctor”, “Residents may bring their smaller sized belongings”, “Silver Light Care is to inspect and inventory all residents belongings”, and “No homemade food is allowed by families except restaurant orders accompanied with receipt.” LPA interviewed the Administrator. The Administrator stated that the house rules are new and less than one year old. The Administrator stated that they made the house rules themselves and did not review the resident’s personal rights prior to making the rules. The Administrator agreed to change the house rules and send an updated version to the LPA for approval. Based on the information obtained during the physical plant tour and interviews there is sufficient evidence to support the allegation of House rules violate residents personal rights. Therefore, the allegation is deemed Substantiated at this time.

The following deficiencies were cited (refer to LIC 9099Ds). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4