197608349-5-23-2023-31-AS-MVAO-CWQQ4U-20231018115054

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 05/23/2023
Date Signed: 05/23/2023 02:52:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
05/19/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230519164457

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: 63	DATE:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Marine Karapetyan - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff mishandled a resident's personal funds

Staff mishandled a resident's medical needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with administrator Marine Karapetyan and explained the reason for the visit.

LPA conducted physical plant tour at 9:30 AM. Requested copies of facility documents relevant to the investigation at 10:00 AM and interviewed staff and resident between 10:00 AM to 1:00 PM. LPA also conducted records review from 1:00 PM to 3:00 PM. Regarding the allegation that the staff mishandled resident's personal funds, it was alleged that Resident #1 (R1)'s Social Security Supplemental Income (SSI) was switched without R1's permission. LPA's record review between 1:00 PM to 2:30 PM, revealed that R1 has no SSI portion to pay at the facility and the facility is only receiving payment from Los Angeles County Department of Housing Services (LACDHS). LPA's interview with the administrator today at 10:35 AM revealed that R1 was referred to by the Agency (LADHS) and admitted at the facility on 01/04/23. (continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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-20230519164457

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ABBEY ROAD VILLA	FACILITY NUMBER: 197608349
	VISIT DATE: 05/23/2023

NARRATIVE

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(continued from LIC 9099)

Administrator also confirmed that R1 had no Share of Cost (SOC) or SSI portion which is specifically stated in R1's contract with the facility. Further interview also revealed that the administrator tried to assist R1 to get R1's SSI by calling Social Security Administration (SSA) but R1 had no CA ID and was not able to transact any business with SSA without it. The administrator was also told by SSA representative that R1's SSI is being paid to a company in Bakersfield.

Regarding the allegation that Staff mishandled a resident's medical needs, it was alleged that R1 had no regular doctor. LPA's record review today revealed that R1 was seen by a doctor at the facility almost on a monthly basis. Further review revealed that R1 was seen by R1's appointed Primary Care Physician (PCP) on 02/28/23 and 03/20/23, Dermatologist saw R1 on 03/24/23, 04/24/23 and 05/22/23. R1 was also referred to by R1's PCP to see A Gastrointestinal (GI) doctor on 04/28/23. LPA's interview with the administrator today revealed that the appointment for a GI doctor is currently on process awaiting R1's insurance approval before getting an appointment.

Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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