195850245-8-21-2024-29-AS-KHEN-D8JVJT-20240827162917

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850245
Report Date: 08/21/2024
Date Signed: 08/21/2024 02:25:22 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
03/22/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20230322095137

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 are not ensuring that resident's hygiene needs are being met.
Staff are not repositioning resident as necessary.
Staff are not ensuring that resident is being fed in a safe manner.
Staff are not ensuring that resident has clean bedding.
Staff handle resident in a rough manner.

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., the 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 03/27/2023 between 1:53 p.m. and 3:00 p.m., LPA Camara conducted a physical plant tour, reviewed records, conducted an interview with one (1) resident and the Administrator and conducted a phone interview with a witness.

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)

Page: 1 of 3

Control Number 29-AS-20230322095137

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 are not ensuring that resident's hygiene needs are being met. The Department received a complaint on 03/22/2023 alleging that staff do not properly clean Resident #1 (R1). During the physical plant tours on 03/27/2023 and 08/21/2024, LPAs observed residents to be well groomed. Interviews with residents did not reveal any concerns with staff not meeting their hygiene needs. Interviews with staff and Administrator revealed that residents get bathed twice a week. Additionally interview with R1’s family member did not have any concerns regarding R1’s care and hygiene needs. 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 allegations: 2.) Staff are not turning resident as necessary. The Department received a complaint on 03/22/2023 alleging that staff do not reposition Resident #1 (R1). Interviews with residents revealed that staff do reposition residents throughout the day. Interview with staff and Administrator revealed that staff reposition residents every two hours or as needed. 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 allegations: 3.) Staff are not ensuring that resident is being fed in a safe manner. The Department received a complaint on 03/22/2023 alleging that staff do not ensure Resident #1 (R1) is positioned properly before eating to prevent any choking. Interviews with the Administrator revealed that staff do supervise R1 and other residents while eating. The Administrator stated that R1 and other residents can feed themselves, however, do require supervision for their safety. No concerns were brought up during resident interviews regarding supervision during meals. 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.

Contiued 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-20230322095137

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: 4.) Staff are not ensuring that resident has clean bedding. The Department received a complaint on 03/22/2023 alleging that staff do not ensure Resident #1’s (R1’s) sheets are changed and cleaned. During the physical plant tours on 03/27/2023 and 08/21/2024, LPAs observed all residents’ beds with clean linens. Interviews with residents revealed that staff and clean change their linens daily and weekly. Staff interviews revealed that staff change linens as need which could be daily. 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 allegations: 5.) Staff handle resident in a rough manner. The Department received a complaint on 03/22/2023 alleging that Staff #1 (S1) handled Resident #1 (R1) in a rough manner. Interviews with residents, including R1 revealed that staff including S1 are very gently with residents and had no complaints regarding staff. Additionally interview with R1’s family member did not have any concerns regarding R1’s care or staff. 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.

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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