195850349-8-17-2023-29-AS-DPEA-CV6NP3-20230829103740

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850349
Report Date: 08/17/2023
Date Signed: 08/17/2023 05:36:24 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
08/11/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20230811134049

FACILITY NAME:	LOVING CARE FACILITY INC.		FACILITY NUMBER:	195850349
ADMINISTRATOR:	NSHANYAN, HASMIK		FACILITY TYPE:	740
ADDRESS:	15107 BURTON ST		TELEPHONE:	(310) 993-2441
CITY:	PANORAMA	STATE: CA	ZIP CODE:	91402
CAPACITY:	4	CENSUS: 2	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Hasmik Nshanyan Administrator		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Staff are billing resident in excess of the agreed rate

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Emily Peraldi and Martha Arroyo conducted an unannounced initial complaint visit to this facility for the allegations noted above. At 8:15 a.m., the LPAs met with staff and explained the reason for the visit. At 8:50 a.m., the Administrator arrived at the facility. Entrance interview conducted.

At 8:20 a.m., the LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards. LPA Peraldi conducted interviews with one (1) resident and the Administrator at 8:23 a.m. and 9:02 a.m. At 9:06 a.m., the LPAs reviewed and requested copies of pertinent documents. Additionally, at 11:01 a.m., LPA Peraldi conducted an interview with Individual#1 (I1). At 3:51 p.m., LPA Peraldi conducted an interview with a resident’s responsible person.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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-20230811134049

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: LOVING CARE FACILITY INC.	FACILITY NUMBER: 195850349
	VISIT DATE: 08/17/2023

NARRATIVE

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Regarding the allegation: Staff are billing resident in excess of the agreed rate. The Department received a complaint on 08/11/2023 regarding the facility charging a different amount from the agreed rate that was given to Individual #1 (I1). It was alleged that I1 was living at the facility for an agreed rate of $800; however, I1 was offered and accepted another room at the accessory dwelling unit (ADU) at the back of the facility for $1200. During the interview with the Administrator, it was revealed that I1 was never a resident at the facility but rather a tenant living at the ADU, an independent living facility located behind the facility. The Administrator denied the allegation of charging her current residents more than the agreed rate. Furthermore, interview conducted with I1 did not provide additional information to support the above allegation. 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 Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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