195850360-9-4-2024-29-AS-KLOZ-D9GSP4-20240926140232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850360
Report Date: 09/04/2024
Date Signed: 09/04/2024 03:48:22 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
08/26/2024 and conducted by Evaluator Trevor Byrne

COMPLAINT CONTROL NUMBER: 29-AS-20240826171216

FACILITY NAME:	AY SENIOR CARE INC		FACILITY NUMBER:	195850360
ADMINISTRATOR:	CLAUDIA HESHMATI		FACILITY TYPE:	740
ADDRESS:	6623 VESPER AVE		TELEPHONE:	(818) 404-0550
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	6	CENSUS: 3	DATE:	09/04/2024
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Claudia Heshmati		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not accord privacy to resident in care.
Staff intimidate resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation at the facility today beginning 09:19 AM. LPA met with facility staff who contacted the facility administrator, Claudia Heshmati, and the facility designee, Kevin Ohanian, via telephone call. At 09:50 AM, Administrator and facility designee arrived at the facility. The reason for today’s visit was explained and entrance interview was conducted.

During today's inspection, the LPA conducted a review of resident files beginning at 09:58 AM. Between 10:20 AM and 12:01 PM, LPA interviewed three (3) current residents, three (3) staff members, one (1) former resident (Resident #1), and one (1) Witness.

Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion: 14

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

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-20240826171216

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: AY SENIOR CARE INC	FACILITY NUMBER: 195850360
	VISIT DATE: 09/04/2024

NARRATIVE

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The allegation of 'Staff do not accord privacy to resident in care' alleges that Staff #1 (S1) did not give Resident #1 (R1) privacy while making phone calls to family members. During the interview with Witness #1 (W1), they stated they have heard S1 in the background during phone calls with R1 and have spoken with S1 during phone calls with R1. W1 stated that at times, S1 would take the phone during conversations with R1 and interject. The interview with R1 revealed S1 would sometimes be present in the room when they were on the telephone but R2 did not express concerns with the presence of S1. The interview with S1 revealed that they had been present during some of R1’s personal telephone calls. However, S1 was only present when requested by R1. S1 stated that R1 refused to close any of the doors to their room and would get combative with staff if they ever attempted to close a door. Interviews with the three current residents residing at the home revealed no issues or concerns pertaining to not having privacy when making personal phone calls or when having visitors. Furthermore, the LPA observed all resident bedroom doors to latch securely and afforded privacy to residents. Additionally, other staff interviewed revealed no complaints from residents of being afforded privacy when making personal phone calls. Based on the information obtained, although the allegation may have happened or is valid, there is insufficient evidence to support the allegation of Staff do not accord privacy to resident in care occurred. Therefore, the allegation is deemed Unsubstantiated at this time.

The allegation of ‘Staff intimidate resident in care’ alleges S1 intimidated R1 by stating a new car that a family member of R1 had recently purchased was with R1’s money and that was why R1’s rent was not being paid. It is also alleged that S1 stated they deserved a new car more than the family member. During the interview with R1, R1 stated they were not aware that their family member had purchased a new car. The interview with S1 revealed that they were unable to recall ever making a comment about the family member’s new car to the resident. Although, R1 was behind on their rent, and it was frustrating to see their family member purchase a new luxury car. The interview with W1 revealed that the savings of R1 were exhausted due to the cost of the facility and W1 attempted to work with Licensee regarding making payments. Resident interviews revealed they have never been approached by staff asking for gifts or coercing them in any way. Staff interviews also revealed no current residents had any issues or concerns with staff members coercing money or gifts from them. Based on the information obtained, although the allegation may have happened or is valid, there is insufficient evidence to prove the allegation of Staff intimidate resident in care occurred. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240826171216

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: AY SENIOR CARE INC	FACILITY NUMBER: 195850360
	VISIT DATE: 09/04/2024

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 facility administrator was unavailable to sign this report although they designated Kevin Ohanian, facility designee, to sign on their behalf. Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

LIC9099 (FAS) - (06/04)

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