197608349-6-1-2023-31-AS-TAGD-CYAUWS-20231207145707

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 06/01/2023
Date Signed: 06/01/2023 03:02:20 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: 63	DATE:	06/01/2023
		UNANNOUNCED	TIME BEGAN:	08:47 AM
MET WITH:	Marine Karapetyan - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not ensure facility was free from pests

Food is not of nutritious enough to meet the needs of residents

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 9:28 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and conducted interview with staff and residents between 11:00 AM to 2:00 PM.

Regarding the allegation that the facility did not ensure that the facility was free from pests, it was alleged that Resident #1 (R1) saw cockroaches roaming in own room, LPA's interview today with seven (7) residents or more than 10% of the current census between 11:00 AM to 2:00 PM, revealed that seven (7) out of seven (7) residents did not see any cockroaches roaming in their room or anywhere at the facility. LPA's interview with the administrator today between 11:00 AM to 2:00 PM also revealed that she already scheduled a pest control treatment for outside surroundings this coming Saturday (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: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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: 06/01/2023

NARRATIVE

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(continued from LIC 9099)

To ensure that there is no infestation at the facility. LPA's record review today at 2:15 PM also revealed that the facility has a contracted pest control company that visit the facility every month to treat scheduled resident rooms and common areas to ensure that there is no pest infestation at the facility.

Regarding the allegation that the Food is not nutritious enough to meet the needs of residents, it was alleged that the facility is only serving "junk food". LPA's observation today revealed that the facility's lunch today consists of green pea soup, tuna sandwich, crab salad and a slice of fruit, which is exactly what was written on their monthly menu. LPA's observation also revealed that today, they have an alternate menu of turkey sandwich in case a resident did not like what they are serving for lunch today. LPA's interview with seven (7) residents today between 11:00 AM to 2:00 PM revealed that seven (7) out of seven (7) residents like the food served today and like the food at the facility in general. All seven (7) residents also stated that the food served is nutritious enough for them.

Based on the information gathered during this visit, the above 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: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC9099 (FAS) - (06/04)

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