197608349-10-19-2020-31-AS-MVAO-C4GLPJ-20210630085602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 10/16/2020
Date Signed: 10/19/2020 02:28:33 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
04/06/2020 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20200406125558

FACILITY NAME:	ABBEY ROAD VILLA		FACILITY NUMBER:	197608349
ADMINISTRATOR:	MARINE KARAPETIAN		FACILITY TYPE:	740
ADDRESS:	14132 HUBBARD STREET		TELEPHONE:	(818) 837-0077
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	78	CENSUS: 55	DATE:	10/16/2020
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Marine Karapetian - Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff left resident in soiled diaper for an extended period of time.

Facility is not providing quality food to the residents

Staff is threatening to evict resident in care

Facility is not kept odor free

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted a subsequent complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically. LPA met with the Administrator Marine Karapetian and explained the reason for today’s visit.

During the initial visit, LPA Tan obtained copies of the facility records, conducted interviews with the Administrator, staff and residents of the facility. Regarding the allegation that staff left resident in soiled diaper for an extended period of time, LPA interview with Resident #1 (R1) revealed that R1 was not left with soiled diaper, it just takes caregiver too long to get to R1. LPA record review revealed that R1 needed two (2) person assist on changing diapers and being changed regularly by staff based on schedule. LPA interview with staff also revealed that R1 calls almost every hour for a change of diaper and sometime during lunch and dinner time which caregivers are busy assisting other residents. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2020

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-20200406125558

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: ABBEY ROAD VILLA	FACILITY NUMBER: 197608349
	VISIT DATE: 10/16/2020

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that the facility is not providing quality food to the residents, LPA interview with six (6) residents or 10% of the current population of the facility, revealed that the facility provide sufficient and quality foods. LPA menu review and observation also revealed that the food being served were deemed nutritious and varied.

Regarding the allegation that staff is threatening to evict resident in care, LPA interview with staff revealed that R1 was not threatened with eviction, R1 was told that if R1 needed higher level of care, R1 may need to be transferred to a higher level care facility.

Regarding the allegation that the facility is not kept odor free, LPA interview with R1 revealed that R1 did not witness anyone smoking inside the facility. Moreover, LPA interview with six (6) residents or 10% of the population also revealed that no one witnessed anyone smoking nor smelled cigarette inside the facility.

Based on the information gathered during the course of the investigation, the allegations are deemed unsubstantiated at this time.

A telephonic exit interview was conducted with Administrator Marine Karapetian and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2020

LIC9099 (FAS) - (06/04)

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