197608349-1-4-2024-31-AS-TAGD-D77NGK-20240715102712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 01/04/2024
Date Signed: 01/04/2024 01:59:18 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
01/02/2024 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20240102165554

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:	DATE:	01/04/2024
		UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	Marine Karapetian - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not safeguard resident's money

INVESTIGATION FINDINGS:

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

LPA conducted physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and reviewed records from 10:30 AM to 12:00 PM. LPA also conducted interviews with administrator and resident between 12:05 PM to 1:18 PM. It was alleged that Resident #1 (R1) disclosed to the Reporting Party (RP) that R1 should be receiving $300 a month and that at the end of the month, R1 only has $180 left in own account when it should have been around $600 because R1 has not spent any money in the past couple of months. LPA's record review at 10:30 AM, revealed that R1 is a client of Los Angeles County Department of Health Services (LACDHS) under their program Flexible Housing Subsidy Pool Program (FHSPP) and the ones paying for R1's stay at the facility. (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: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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-20240102165554

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: 01/04/2024

NARRATIVE

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(continued from LIC 9099)

The program also provides R1 with $168/month personal allowance similar to that of Supplemental Security Income (SSI)'s Personal and Incidental Needs allowance (PNA). Further review also revealed that the facility is not the payee of R1's SSI if R1 is at all enrolled to or eligible to receive SSI. Moreover, LPA's review of R1's PNA's record confirmed that R1 is taking cash money periodically and disbursed only by the administrator. LPA's interview with R1 at 1:00 PM confirmed R1's signature on the PNA log of the facility. LPA's further review of R1's PNA's log revealed that R1 withdraws cash money from R1's PNA account an average of 6-7 times for the last three (3) months and the remaining cash balance is accurate which is also confirmed by R1 during the interview.

Based on the information gathered during this visit, the allegation is 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: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC9099 (FAS) - (06/04)

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