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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607892
Report Date: 11/27/2024
Date Signed: 11/27/2024 12:34:13 PM

Substantiated


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
11/22/2024 and conducted by Evaluator Trevor Byrne
COMPLAINT CONTROL NUMBER: 29-AS-20241122092346
FACILITY NAME:CHRISTINE'S RETREATFACILITY NUMBER:
197607892
ADMINISTRATOR:GEVORG MKRTCHIANFACILITY TYPE:
735
ADDRESS:14712 KILLION STREETTELEPHONE:
(818) 387-8572
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91411
CAPACITY:6CENSUS: 4DATE:
11/27/2024
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Marsha WilliamsTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not properly maintain the facility grounds
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 9:26 a.m. LPA met with facility staff who contacted the facility backup Administrator Marsha Williams via phone call. The backup Administrator arrived to the facility at approximately11:30 a.m. the reason for the visit was explained and entrance interview was conducted.

During today’s visit LPA conducted a physical plant tour, interviewed two (2) facility staff members, the facility handy-man, and the facility backup Administrator between 09:27 a.m. and 12:30 p.m.

Continued on LIC-9099C
Substantiated
Estimated Days of Completion: 7
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024
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-20241122092346
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: CHRISTINE'S RETREAT
FACILITY NUMBER: 197607892
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2024
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
This requirement is not met as evidenced by:
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Licensee will submit proof of completed repairs to the identified areas to CCLD no later than POC due date.
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Based on observation and interview the licensee did not comply with the section cited above as LPA observed 4 sets of blinds, 1 toilet, 2 sheds, 1 closet, and 1 bathroom wall to be in disrepair. which poses a potential health, safety, and personal rights risk to clients in care.
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Type B
12/11/2024
Section Cited
CCR
85088(d)
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85088 Fixtures, Furniture, Equipment and Supplies
(d) If the facility operates its own laundry, necessary supplies shall be available and equipment shall be maintained in good repair.
This requirement is not met as evidenced by:
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Licensee will submit proof of repaired or replaced washing machine to CCLD no later than POC due date.
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Based on observation and interview the licensee did not comply with the section cited above as 1 washing machine was observed to be in disrepair. which poses a potential health and personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20241122092346
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: CHRISTINE'S RETREAT
FACILITY NUMBER: 197607892
VISIT DATE: 11/27/2024
NARRATIVE
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The allegation of “Staff did not properly maintain the facility grounds” alleges that the facility and it’s grounds are not kept in good repair. On 11/22/2024 Community Care Licensing Division (CCLD) received a complaint accompanied with photographs alleging that Client #1’s (C1) room had a large crack in the drywall extending from the ceiling to the wall of the room. During the physical plant tour LPA observed four (4) sets of blinds, one (1) toilet, one (1) washing machine, two (2) sheds, one (1) closet, and one (1) bathroom wall to be in disrepair. During the physical plant tour LPA observed the crack in C1’s room to be repaired appropriately. Interviews with facility staff revealed that once they identify anything in the facility needing repairs they inform the facility Administrator. The Administrator then contacts the facility handy-man to perform the requested repairs. Facility staff stated that they have informed the Administrator of the items that are in disrepair but repairs have not been made yet. Additionally, facility staff stated that sometimes when things are reported to the Administrator they are not repaired. The facility Handy-man stated that they were not made aware of the washing machine or bathroom wall being in disrepair and only found out about the toilet needing repair yesterday. When interviewed the facility backup Administrator stated that all repair requests are handled by the facility Administrator Gevorg Mkrtchian. The backup Administrator stated that they were aware of the identified items being in disrepair but were unaware of the sheds, the bathroom wall, and the washer. Based on the information obtained during the interviews and the physical plant tour there is sufficient evidence to support the allegation of Staff did not properly maintain the facility grounds. Therefore, the allegation is deemed Substantiated at this time.

The following deficiencies were cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024
LIC9099 (FAS) - (06/04)
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