197607123-3-20-2023-31-AS-NMAN-D2EQXX-20240213113415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607123
Report Date: 03/20/2023
Date Signed: 03/20/2023 04:44:38 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
02/14/2023 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20230214165012

FACILITY NAME:	ENCINO LIVING		FACILITY NUMBER:	197607123
ADMINISTRATOR:	O. ALMANY & D. PETRASEK		FACILITY TYPE:	740
ADDRESS:	16710 MAGNOLIA BLVD.		TELEPHONE:	(818) 907-1343
CITY:	ENCINO	STATE: CA	ZIP CODE:	91436
CAPACITY:	6	CENSUS: 5	DATE:	03/20/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Sharon Abrigo		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff not providing adequate services to residents in care
Residents not being provided activities
Staff engaging in inappropriate behavior while residents were present

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tihesha Smith made an unannounced subsequent complaint visit to this facility at 10:20 am. LPA Smith met with the administrator and disclosed the purpose of this visit.

LPA Tihesha Smith made two visits to this facility on 02/21/23 and 03/13/23. On 03/13/23, LPA Smith delivered findings for three of seven allegations.
During initial visit, on 02/21/23, LPA Smith conducted tour of physical plant, conducted interviews with staff and requested documents relevant to the investigation.

It was alleged that staff are not providing adequate services to residents in care. Interviews with administrator revealed each resident is provided basic services and optional services according to their admissions agreement. During several visits to the facility during the course of the investigation, LPA Smith observed staff preparing meals for residents, engaging residents to assess any needs,

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

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 31-AS-20230214165012

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: ENCINO LIVING	FACILITY NUMBER: 197607123
	VISIT DATE: 03/20/2023

NARRATIVE

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(Cont. from 9099)

and providing toileting services.

Based on interviews and observation there is insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Residents not being provided activities

It was alleged that residents are not being provided activities. Interviews with administrator revealed that activity coordinator comes to the facility each day. S1 revealed some activities include outdoor workout, drawings, and puzzles. During today’s visit coordinator was present at the facility. Brief discussion with coordinator revealed they wait until residents are up and dressed then begin activities. LPA observed activity coordinator with a puzzle or game back at kitchen table.

Based on interviews and observation there is insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time

Staff engaging in inappropriate behavior while residents were present

It was alleged that staff engaging in inappropriate behavior while residents were present. Interviews with staff both on am and pm shifts revealed they have not engaged in inappropriate behavior while residents were present. LPA unable to conduct interviews with residents as five (5) of five (5) residents did not understand, were unresponsive to questions, and/or have Alzheimer or dementia.

Based on interviews and record review there is insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted/copy of report given.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023

LIC9099 (FAS) - (06/04)

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