197608312-3-22-2021-31-AS-NGID-BZLSUU-20210330141141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608312
Report Date: 03/22/2021
Date Signed: 03/22/2021 03:13:46 PM

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
09/09/2020 and conducted by Evaluator Naira Margaryan

COMPLAINT CONTROL NUMBER: 31-AS-20200909095840

FACILITY NAME:	ADL BEST CARE LLC		FACILITY NUMBER:	197608312
ADMINISTRATOR:	ANNA VARDANYAN		FACILITY TYPE:	740
ADDRESS:	5433 MONROE STREET		TELEPHONE:	(323) 461-5602
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90038
CAPACITY:	5	CENSUS: 5	DATE:	03/22/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Anna Vardanyan		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not administer medication to resident.

Staff spoke inappropriately to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Naira Margaryan conducted subsequent complaint visit to the facility to complete an investigation of the above noted allegations.
Due to the situation surrounding the Corona virus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with the Administrator Anna Vardanyan. The purpose of visit was discussed.

--- Staff did not administer medication to resident.
It was alleged that the facility staff did not administer required medication to the resident #1 (R1).

To investigate the allegation, on 09/09/2020 at 10:45am and on 03/21/2021 at 3:00pm, LPA spoke with the Administrator, who was providing medication assistance to R1. In addition, at 11:00am, LPA spoke with four (04) out of five (05) residents via face time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Naira Margaryan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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-20200909095840

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: ADL BEST CARE LLC	FACILITY NUMBER: 197608312
	VISIT DATE: 03/22/2021

NARRATIVE

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The Administrator stated that the medication was dispensed to the R1 as per medication administration records and doctor’s instructions. However, at times R1 was refusing to take their medications for various reasons.
Other residents, interviewed on 09/14/2020 at 10:45am, did not have any concerns about their medication assistance.
On 09/14/2020 at 8:30am and 09/15/2020 at 3:00pm LPA Margaryan spoke with R1’s family members and they verified information received from the Administrator.
A review of R1’s medication records conducted on 03/21/2020 at 5:00pm, did not reveal any information to support the allegation.
Based on the interviews and record review there is no sufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff spoke inappropriately to resident.
It was reported that R1 went to the hospital and the staff told R1 not to come back.

To investigate the allegation, on 09/09/20 at 10:45am LPA spoke with the Administrator, who denied talking to R1 inappropriately or telling her not to come back to the facility.
On 09/09/2020 at 11:00am four (04) out of five (05) residents were interviewed and no one addressed any concerns about staff talking to them inappropriately.
On 09/14/2020 at 8:30am and 09/15/2020 at 3:00pm and LPA Margaryan spoke with R1’s family members and they indicated that R1 never complain about staff talking to them inappropriately.
The information revealed during this investigation does not support the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No other issues were noted during this investigation.

Exit interview was conducted telephonically and a copy of report was e-mailed to the Administrator for review and signature.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Naira Margaryan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

LIC9099 (FAS) - (06/04)

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