195850245-8-21-2024-29-AS-KHEN-D8M62P-20240829202550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850245
Report Date: 08/21/2024
Date Signed: 08/21/2024 02:26:49 PM

Unsubstantiated

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
04/30/2024 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20240430154047

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: 6	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Zaruhi Harutyunyan, Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff left resident in soiled diapers for an extended period of time.
Staff does not meet the needs of resident in a timely manner.
Staff did not provide adequate food service to resident in care.
Staff does not assist resident with transfers to wheelchair.
Staff are unable to communicate with resident due to language barrier.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Emily Peraldi and Trevor Byrne conducted an unannounced subsequent complaint visit to this facility. At 9:35 a.m., the LPAs met with staff and explained the reason for the visit. At 9:36 a.m., Administrator Zaruhi Harutyunyan, arrived at the facility.

During today’s visit, between 9:37 a.m. and 10:48 a.m., the LPAs conducted a physical plant tour, a record review and interviewed the Administrator, one (1) staff and five (5) residents. During the initial visit, on 05/02/2024 between 12:50 p.m. and 2:20 p.m., LPA Peraldi conducted a physical plant tour, conducted interviews with three (3) residents and one (1) staff, the Administrator and with a resident’s family member. During the initial visit, the LPA also requested and obtained copies of pertinent documents.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240430154047

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: SG CARE	FACILITY NUMBER: 195850245
	VISIT DATE: 08/21/2024

NARRATIVE

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Regarding the allegations: 1.) Staff left resident in soiled diapers for an extended period of time. 2.) Staff does not meet the needs of resident in a timely manner. The Department received a complaint on 04/30/2024 alleging that staff did not change R1’s diaper in a timely manner leaving R1 in a soiled diaper for an extended period of time. During the physical plant tours on 05/02/2024 and 08/21/2024, LPAs did not observe any foul odors that may have indicated soiled diapers. LPAs observed pendants for each resident. Residents ring their pendant when they need to use the bathroom or if they need a diaper change. Interviews with staff and the Administrator revealed that staff change residents’ diapers 3 times a day or as needed. Interviews with residents reveal that staff do change their diapers as needed and do not leave residents with soiled diapers. Resident interviews revealed that staff do assist residents in a timely manner. Additionally interview with R1’s family member did not have any concerns regarding R1’s care. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed Unsubstantiated at this time.

Regarding the allegation: 3.) Staff did not provide adequate food service to resident in care. The Department received a complaint on 04/30/2024 alleging that Resident #1 (R1) was served cold soup. During the physical plant tours on 05/02/2024 and 08/21/2024, LPAs observed sufficient amount of perishable and nonperishable food. Interviews conducted with residents revealed that residents had no complaints regarding the food and stated that they enjoyed the food that is served. Interviews with staff revealed that staff cook food that residents prefer. Staff stated that they always include fruits, vegetables, and protein for each meal and or snacks. Administrator provided photos of various meals served to residents to the LPAs. Additionally interview with R1’s family member did not have any concerns regarding R1’s food service. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Continued on LIC 9099-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240430154047

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: SG CARE	FACILITY NUMBER: 195850245
	VISIT DATE: 08/21/2024

NARRATIVE

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Regarding the allegation: 4.) Staff does not assist resident with transfers to wheelchair. The Department received a complaint on 04/30/2024 alleging that Resident #1 (R1) does not receive assistance with transfers to wheelchair. Interviews with residents revealed that staff do assist residents with transfers to wheelchair. Resident interviews revealed that staff assist with transfers to wheelchair daily or when requested. Interviews with staff revealed that residents get transferred to their wheelchairs for their meals, outdoor time and when residents request to do be on their wheelchairs. Additionally interview with R1’s family member did not have any concerns regarding R1’s care. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Regarding the allegation: 5.) Staff are unable to communicate with resident due to language barrier. The Department received a complaint on 04/30/2024 alleging that Staff #1 (S1) is unable to communicate with residents since S1’s primary language is not English. Interviews with residents revealed that staff, including S1, are able to properly communicate with residents and if there are issues, staff and S1 call the Administrator for assistance. Resident interviews did not reveal any concerns with staff and S1’s communication. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

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