197608349-8-3-2023-31-AS-MVAO-CWQQ4T-20231018115053

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 08/03/2023
Date Signed: 08/03/2023 02:31:41 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: 70	DATE:	08/03/2023
		UNANNOUNCED	TIME BEGAN:	08:49 AM
MET WITH:	Marine Karapetyan - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not seek timely medical attention for a resident

Staff do not meet a resident's needs while in care

INVESTIGATION FINDINGS:

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

LPA conducted physical plant tour at 9:12 AM, requested additional documents relevant to the investigation at 9:43 AM, interviewed resident, staff and third party Social worker betweeen 10:00 AM to 12:30 PM and reviewed records between 12:30 PM to 2:00 PM.

Regarding the allegation that Staff did not seek timely medical attention for a resident, it was alleged that Resident #1 (R1) had an existing non-emergency medical condition that needed attention but haven't got one since moving at the facility. LPA's record review on prior visit on 05/23/23 between 1:00 PM to 2:30 PM revealed that the facility staff had been trying to get an appointment for R1's non-emergency medical condition but was not able to because of pending medical insurance approval, Specialist's and Social worker'savailability schedule. (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: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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: 08/03/2023

NARRATIVE

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(continued from LIC 9099)

LPA's record review today between 12:30 PM to 2:00 PM revealed that R1 was seen by a regular doctor for R1's non-emergency medical condition on 05/30/23 to address R1's non-emergency medical issue. LPA's interview with the staff today at 10:23 AM revealed that they were coordinating closely with R1's Social Worker and now have a confirmed schedule on 09/11/23 with the Specialist doctor. LPA's phone interview with R1's Social worker today confirmed R1's appointment with the Specialist doctor

Regarding the allegation that Staff do not meet a resident's needs while in care, it was alleged that R1 was completely isolated and unable to eat the food at the facility. LPA's record review between 12:30 PM to 2:00 PM revealed that R1 had no dietary restriction except allergies for some food and soft foods due to poor dental condition. LPA's observation during visit also revealed that the allergy restriction of R1 is prominently displayed on the kitchen to ensure that R1 is not served food R1 is allergic to. LPA attempted to interview R1 multiple times but was always asleep during visit. LPA's interview with three (3) staff today between 10:00 AM to 12:30 PM revealed that R1 is always almost asleep during day time and awake at night. Further, R1 only eat breakfast at the dining room and always go out at night and buy own food at the nearby store.

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: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

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