197605175-3-29-2023-31-AS-NMAN-CR3UX5-20230420155747

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197605175
Report Date: 03/29/2023
Date Signed: 03/29/2023 02:56:20 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/03/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230103114611

FACILITY NAME:	GOCHIN CARE FACILITY		FACILITY NUMBER:	197605175
ADMINISTRATOR:	RHODA GOCHIN		FACILITY TYPE:	735
ADDRESS:	8112 LOMA VERDE AVENUE		TELEPHONE:	(818) 349-1767
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91304
CAPACITY:	4	CENSUS: 4	DATE:	03/29/2023
		UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Rhoda Gochin		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not seek medical attention to resident in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with the administrator, Rhoda Gochin, and explained the reason for the visit.

--- Staff did not seek medical attention to resident in a timely manner.

It was alleged that Resident #1 (R1) did not get medical attention timely. To investigate this allegation on 01/09/2023, LPA interviewed other parties at 8:45 AM, requested pertinent documents at 10:00 AM and interviewed one (01) staff and one (01) residents between 10:30 AM to 11:30 AM. LPA unable to interview remaining three (03) residents as they were at Day Program. During interviews with other parties, they stated that they do not know how long R1 was in a physical or mental state that required medical attention and called the paramedics when they noticed something was wrong on 11/28/2022.
(CONT. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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 2

Control Number 31-AS-20230103114611

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GOCHIN CARE FACILITY	FACILITY NUMBER: 197605175
	VISIT DATE: 03/29/2023

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

Other parties also stated that on 01/02/2023, R1 attended Day Program with a wound on R1’s forehead and dried blood. Record review shows that R1 was taken to the hospital for medical attention on 11/28/2022 but the condition identified on the medical record can be undetectable in many cases as there are often no physical signs to alert one’s self or others. During interviews with Staff #1 (S1) they stated that on 11/28/2022, R1 went to Day Program without any noticeable issues. S1 also stated that on 01/02/2023, R1 sustained a minor injury from a fall and they cleaned it. A relative of R1 came to transport them to Urgent Care, but R1 was taken to Day Program instead. S1 stated that upon R1’s return, they learned that R1 was not taken to Urgent Care, so they called the paramedics. During interviews with R1, they stated that did not have any medical issues as stated by other parties on 11/28/2022 and that the wound from 01/02/2023 was just a small cut from a fall.

Based on record review and interviews, there is not enough information to verify the allegation, therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2