197608349-11-2-2023-31-AS-TAGD-D3SMJA-20240328093848

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 11/02/2023
Date Signed: 11/02/2023 03:04:32 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
06/26/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230626114348

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:	11/02/2023
		UNANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:	Marine Karapetyan - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility towels are unsanitary
Facility racially discriminates against a resident in care
Facility left resident in a soiled diaper for a long period of time

INVESTIGATION FINDINGS:

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

LPA conducted physical plant tour at 9:20 AM, requested copies of facility records at 9:43 AM, reviewed records between 10:00 AM to 11:30 AM and interviewed residents and staff between 11:30 AM to 1:30 PM. Regarding the allegation that the Facility towels are unsanitary, it was alleged that face towels and other towels have hair on them. LPA's interview with seven (7) random residents or 10% of the current census today between 10:00 AM to 1:30 PM, revealed that seven (7) out of seven (7) residents interviewed did not see any hair on the fresh towels they get every day or as needed. LPA's interview with staff on 07/05/23 between 10:11 AM to 11:30 AM revealed that staff change towels of every resident’s room every day.

(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: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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-20230626114348

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: 11/02/2023

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that the Facility racially discriminates against a resident in care, it was alleged that Resident #1 (R1) is "black" and that whenever R1 rings own call light, R1 had to wait a long time to get changed while the Hispanic resident next to R1 get to be changed right away. LPA's interview with seven (7) random residents or 10% of the current census today between 10:00 AM to 1:30 PM, five (5) of which are African American and four (4) are incontinent, revealed that seven (7) out of seven (7) residents interviewed did not experience any discrimination from any staff and believed that they were all treated with dignity and respect by all the staff.

Regarding the allegation that Facility left resident in a soiled diaper for a long period of time, it was alleged that R1 had to wait a long time to get changed. LPA's record review today between 10:30 AM to 11:00 AM revealed that Reporting Party (RP) lodged the same allegation on prior complaints (complaint control number: 31-AS-20200406125558 and 31-AS-20230530153549) and were both unsubstantiated. LPA's interview with seven (7) random residents or 10% of the current census today between 10:00 AM to 1:30 PM, four (4) of which are incontinent, revealed that seven (7) out of seven (7) residents interviewed that staff came whenever they call within reasonable time or within fifteen (15) minutes and all four (4) incontinent residents stated that they were changed regularly on time.

Based on the information gathered during this and prior visit, these 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: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC9099 (FAS) - (06/04)

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