195850245-3-7-2023-29-AS-JAPL-CQ5UQT-20230321154740

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850245
Report Date: 03/07/2023
Date Signed: 03/07/2023 01:14:56 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
03/03/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230303092310

FACILITY NAME:	SG CARE		FACILITY NUMBER:	195850245
ADMINISTRATOR:	HARUTYUNYAN, ZARUHI		FACILITY TYPE:	740
ADDRESS:	7920 VANTAGE AVENUE		TELEPHONE:	(818) 397-2656
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 5	DATE:	03/07/2023
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Zaruhi Harutyunyan		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not allowing resident a visit with a family member.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst(LPA), Sandra Urena conducted an unannounced visit to investigate the allegation above. The LPA arrived at the facility at 11:25 a.m., was greeted by staff who then contacted the administrator by phone. LPA Urena spoke with the Administrator Zaruhi Harutyunyan,and explained the reason for the visit.
The LPA interviewed the administrator from 12:03 p.m. to 12:37 p.m. and reporting party(RP) from 8:40 a.m. to 9:45 a.m.

On the allegation that ‘Staff are not allowing resident a visit with a family member’; the RP's concern is that they were not allowed to visit R1. The LPA interviewed the complainant on 03/07/2023 at 8:40 a.m., and the interview revealed that facility has indeed allowed them to visit in the past; it was only during the COVID outbreak, which was for a period of two weeks. Additionally, the complainant stated the facility takes very good care of R1, and R1 is doing well at the facility. Continues on LIC 9099 C...

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: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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 2

Control Number 29-AS-20230303092310

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: SG CARE	FACILITY NUMBER: 195850245
	VISIT DATE: 03/07/2023

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 interview with the Administrator revealed that the Administrator contacted all residents' responsible parties to inform them of the outbreak, and to inform them that visits would be cancelled for at least two weeks or 14 days. Additionally, the administrator stated that the residents were able to Face time with the family members, some family members came to visit and communicated with residents through the window, and one resident's family member stayed in contact with the administrator about the resident's well being.

Based on the information obtained through the interviews, there is not enough evidence to support the allegation that Staff are not allowing residents a visit with a family member. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview was conducted with the Administrator, and 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: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2