195850239-8-11-2023-29-AS-KHEN-CUYVMW-20230823163414

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850239
Report Date: 08/10/2023
Date Signed: 08/11/2023 08:48:08 AM

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
06/09/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230609085812

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: 3	DATE:	08/10/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Elba Khachatryan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not follow proper eviction procedures with resident in care.
Staff interfere with resident's visitations.

INVESTIGATION FINDINGS:

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On 08/10/2023, Licensing Program Analysts (LPAs) Sandra Urena, and Angel Ascencio conducted an unannounced visit to deliver the findings for the allegations listed above. The LPAs were greeted by staff, and staff called the administrator via phone. The administrator stated that they were far away from the facility and would be available in approximately in 1.5 hours. The LPAs agreed to come back. LPAs met with Elba Khachatryan, and explained the reason for the visit.

On 06/19/2023, Licensing Program Analyst (LPA), Sandra Urena conducted an unannounced visit to investigate the allegations listed above. LPA met with Administrator Elba Khachatryan, and explained the reason for the visit. At 11:40 a.m. The LPA met with the administrator in the patio area to conduct an interview. The LPA interviewed residents. One interview was conducted in Spanish at 11:05 a.m., and another interview was conducted in English at 10:55 a.m. The LPA requested records for review at 12:15 p.m.
Coninues 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: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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 7

Control Number 29-AS-20230609085812

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: 08/10/2023

NARRATIVE

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Staff did not follow proper eviction procedures with resident in care.
On the allegation that Staff did not follow proper eviction procedures with resident in care, it is the complainant’s concern that the Responsible Party (RP) for R1 received a text message for the eviction of R1, and R1 received a written eviction notice of nonpayment for the dates from 5/1/2023 to 5/31/2023; however, R1 had only lived at the facility for six (6) days from April 24 - May 1, 2023 on the date to the eviction notice. To investigate the allegation, the LPA interviewed the RP, who stated that they had received the eviction notice, but that it was cancelled, and that the administrator had agreed to wait until July 2023 for the payment to be processed by the Social Security Office (SSI), and veteran’s services. The administrator’s interview revealed that they had processed an eviction letter, but that they had not issued the letter to the RP responsible for the monthly payments. Based on the information obtained through interviews, and although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff interfere with residents’ visitations.

On the allegation that the staff interfere with residents’ visitations, it is the complainant’s concern that the staff are telling family members to call ahead of time of the visit and told family members that they cannot see the residents until the rent has been paid. To investigate the allegation, The LPA interviewed the administrator and the complainant, and conducted record review. The LPA interviewed residents’ family members and the interview revealed that one family was told that the visitation was contingent to the payment of the past due rent, and that they were told to call before coming to visit the facility. The LPA asked family members if the Admission Agreement was read before signing the document, and the family members stated that they don’t recall reading everything they signed. The LPA reviewed the Admission Agreement (AA), and found that on page 20 of the AA, paragraph two, the Policies Concerning Family Visits are described. The paragraph states that the "families are invited to visit residents from 9:00 a.m. to 7:00 p.m. every day, and should other visiting times be needed, they need to contact the facility in advance to make arrangements". Family members did not state if the facility staff interfered while attempting a visit in person. The administrator denied the allegation of not allowing family members to visit residents.

Based on the information obtained, and record review, although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time.

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: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 7

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
06/09/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230609085812

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: 3	DATE:	08/10/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Elba Khachatryan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff monitor resident phone calls.
Staff do not provide privacy to residents in care.
Staff did not safeguard resident’s property.

INVESTIGATION FINDINGS:

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Substantiated

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: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 7

Control Number 29-AS-20230609085812

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: 08/10/2023

NARRATIVE

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Pg.2
Staff monitor resident phone calls.
On the allegation that Staff monitor resident phone calls, it is the complainant’s concern that R1 was not allowed to speak with family members and/or Responsible Party (RP), due to nonpayment of the monthly care, and supervision fees. To investigate the allegation the LPA interviewed the complainant, and the interview revealed that the “RP/family members could not make contact with R1 via telephone”. “They called the administrator numerous times and even several times the same day leaving messages, and administrator would not return their calls until days passed”. Furthermore, when staff did answer the facility phone, the staff stated to the RP/family members, “that they could not speak to R1”. Complainant also noticed that another resident’s call was being monitored by staff, because the staff told the resident to hang up the phone. The LPA interviewed the administrator, the administrator denied monitoring calls, but added that because the facility only has one phone, they do limit the time residents use the facility’s phone. The administrator added that this is done to allow all residents to use of the phone for private calls. At the time of the interview, two (2) residents, out of three (3) residents did not have access to a personal cell phone. R2 did not have/own a cell phone, R1’s cell phone was broken.

Based on the information obtained, the preponderance of the evidence supports the allegation that the facility staff monitors telephone calls. Therefore, the allegation is deemed Substantiated at this time.

Staff do not provide privacy to residents in care.

On the allegation that Staff do not provide privacy to residents in care, it is the complainant’s concern that while residents are having visitors, they are not provided privacy during their private conversations. A credible witness stated that while visiting R1, they noted that staff (S1) kept walking by continuously trying to listen to their conversation. A resident’s family member noted that while visiting the resident, the administrator was in or around the resident’s bedroom, and would tell the resident out loud to tell family that the resident was happy at the facility. And after the family moved the gathering to the patio area, the administrator joined the family outside and listened to their conversation. The LPA interviewed the administrator about the allegation, and the administrator denied that the staff or them do not provide privacy to residents.

Based on the information received, and the preponderance of the evidence, there is sufficient evidence to support the allegation that staff do not provide privacy to residents in care. Therefore, the allegation is deemed Substantiated 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: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 7

Control Number 29-AS-20230609085812

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: 08/10/2023

NARRATIVE

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Pg.3
Staff did not safeguard resident’s property.
On the allegation that Staff did not safeguard the residents’ property; it is the concern of the complainant that the staff did not ensure that the new clothes and shoes bought for the resident were safe, and that the cell phone/parts of the phone were broken. The LPA interviewed the resident about the broken cell phone, and the resident stated that they did not know what happened to it, and that the “pin” was not working. Regarding the residents’ clothing, the LPA interviewed the resident about the clothing, but the resident could not say much about it, and did not know how many pieces of clothing they had. The LPA inspected the clothes hanging in the private closet and observed the following pieces: One (1) shirt; two (2) pants; five (5) jackets; two (2) sweatpants; and one (1) sweater. The LPA observed that the clothing the resident was wearing was soiled. The LPA asked how often the staff washed the clothes and the resident replied, “that’s a good question, I don’t know”. At the time of the interview the administrator stated that they did not know what happened to the cell phone, and that the residents keep their own cell phones with them in their room. The laundry for residents is done once-a- day. A credible witness observed that the resident’s clothing was too large for them. The facility staff did not complete the Client/Resident Personal Property and Valuable Form (LIC 621) at the time of admission.

Based on the information obtained and observations made, there is sufficient evidence to support the allegation that the staff did not safeguard the residents’ property, due to the cell phone being broken and staff not aware of the incident. Therefore, the allegation is Substantiated at this time.

Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies are cited (refer to LICs 9099-D).

Exit interview was conducted with the Administrator. A copy of the report and Appeal Rights were issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 29-AS-20230609085812

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/10/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/18/2023 Section Cited CCR 87468.2 (a)(1)	1 2 3 4 5 6 7	Additional Personal Rights(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care... shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in… telephone conversations... This requirement is not met as.	1 2 3 4 5 6 7	Administrator has agreed to review with staff the regulation 87468.2 (a)(1)-and send self-verification via a letter to the CCLD department by 08/18/2023.
	8 9 10 11 12 13 14	Based on observation, the administrator and staff prevented R1 from communicating with family, which poses an immediate health and safety danger to persons in care.	8 9 10 11 12 13 14
Type A 08/18/2023 Section Cited CCR 87468.2(a)(1)	1 2 3 4 5 6 7	(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care shall have all of the following personal rights: (1) To have areasonable level of personal privacy in…visits, communications... This requirement is not met as.	1 2 3 4 5 6 7	Administrator was cited for this violation during a case management visit on 06/21/2023 and was cleared on 07/19/2023.
	8 9 10 11 12 13 14	Based on observation, the administrator and staff monitored visits between R1 and visitors, which poses an immediate health and safety danger to persons in care.	8 9 10 11 12 13 14

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 Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 29-AS-20230609085812

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/10/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/18/2023 Section Cited CCR 8721(b)	1 2 3 4 5 6 7	8721(b)Safeguard for Personal Property & Valuables. Every facility shall take appropriate measures to safeguard residents' ... personal property and ...The licensee shall give the residents receipts for all such articles...This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator has agreed to review with staff the regulation 8721(b), and send self-verification via a letter to the CCLD department by 08/18/2023.
	8 9 10 11 12 13 14	Based on interviews, the administrator did not comply with the section cited above when the licensee failed to safeguard the cell phone and… the licensee failed to give receipts for all resident’s articles which posed a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

Page: 7 of 7