195850350-10-9-2024-29-AS-KLOZ-DAJ2GT-20241029172339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850350
Report Date: 10/09/2024
Date Signed: 10/09/2024 02:30:34 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
10/08/2024 and conducted by Evaluator Erica Mosley

COMPLAINT CONTROL NUMBER: 29-AS-20241008153859

FACILITY NAME:	LA SENIOR HOME		FACILITY NUMBER:	195850350
ADMINISTRATOR:	SPRY, NAIRA		FACILITY TYPE:	740
ADDRESS:	7825 SIMPSON AVENUE		TELEPHONE:	(818) 299-7501
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	5	CENSUS: 5	DATE:	10/09/2024
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Administrator- Tigran Gevorgyan Designee - Alisa Manukyan		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Unlawful eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erica Mosley conducted an initial 10-day complaint visit to investigate the above allegation. Upon arrival at 10:20 AM, LPA Mosley were greeted by Administrator, Tigran Gevorgyan and Designee Alisa Manukyan and informed them of the visit and the reason for the visit was explained.

On 10/08/2024, the Department received a complaint regarding the following allegation, Unlawful eviction. LPA toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and the facility is in compliance with Title 22 Regulations.

Report Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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-20241008153859

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: LA SENIOR HOME	FACILITY NUMBER: 195850350
	VISIT DATE: 10/09/2024

NARRATIVE

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On the allegation, unlawful eviction, it is the concern of the Reporting party (RP) that the facility is refusing to accept Resident (R1) back into care after being released from the hospital and did not issue R1 a thirty (30) day eviction notice. To investigate this complaint, LPA conducted in person interviews with Administrator, Designee, staff, and a telephonic interview with R1’s Responsible Party (RP) from 10:25am – 11:50am. The LPA reviewed records, including unusual incident/injury reports submitted dated 09/24/2024 and 09/28/2024, and obtained pertinent documents to the investigation.

Interviews with Administrator and Designee revealed that R1 moved into the facility 09/23/2024 and less than 24 hours of residing at the facility became combative and aggressive towards staff. Facility contacted R1’s RP on 09/24/2024 and was advised to call 911. R1 was transferred to the hospital and was placed on a 51/50 hold. On 09/28/2024 R1 was discharged from the hospital and the facility accepted the resident back. R1’s RP was at the facility when R1 returned. R1 continued to have combative behavior towards staff and the RP called 911. R1 was taken to the hospital again on 09/28/2024 and placed on another 51/50 hold. During the interview with the RP, they stated they gathered all R1’s belongings and notified the facility that R1 would not return, as higher level of care was needed. RP stated R1 was not evicted from the facility, and they initiated the relocation. During the interview with the Administrator, they stated that they would have accepted the resident back upon discharge, but the RP had already stated R1 was not going to return and advised the hospital of this. During the inspection, the LPA did not observe any of R1’s personal belongings in the facility.

Based on information obtained, there is insufficient evidence to support the allegations occurred. Therefore, the allegation the facility issued an unlawful eviction is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report and appeal rights provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC9099 (FAS) - (06/04)

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