197608349-9-27-2023-31-AS-TAGD-CYAUWR-20231207145707

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 09/27/2023
Date Signed: 09/27/2023 02:40:19 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
05/30/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230530153549

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: 72	DATE:	09/27/2023
		UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	Marine Karapetian - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not throw residents diapers away timely

Staff do not answer resident's call bells timely

INVESTIGATION FINDINGS:

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

LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and interviewed staff and residents between 10:23 AM to 1:30 PM. Regarding the allegation that Staff do not throw residents diapers away timely, it was alleged that staff won't throw residents diapers in the garbage and just throw them on the floor. LPA's interview with seven (7) residents on 06/01/23 between 11:00 AM to 2:00 PM and today with four (4) residents between 10:23 AM to 1:30 PM revealed that eleven (11) out of eleven (11) residents did not see any staff throwing or leaving diapers on the floor. Five (5) of the residents interviewed were incontinent and all of them stated that care staff brought their dirty diapers with them when they left their room. (continued on 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: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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-20230530153549

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: 09/27/2023

NARRATIVE

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(continued from LIC 9099)

LPA's interview with three (3) staff today also revealed that all of them bring the dirty diapers to the big garbage bin outside immediately after they change the residents’ diapers.

Regarding the allegation that Staff do not answer resident's call bells timely, it was alleged that staff took so long to assist residents when they call for assistance. LPA's interview with eleven (11) residents or more than 15% of current census revealed that eight (8) of the residents stated that staff respond to their call within reasonable time or not more than fifteen (15) minutes. The other three (3) residents interviewed stated that they did not call for help as they did not need any assistance from staff.

Based on the information gathered during this and prior 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: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC9099 (FAS) - (06/04)

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