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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 07/02/2021
Date Signed: 04/05/2022 01:11:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/28/2021 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20210628093855
FACILITY NAME:ABBEY ROAD VILLAFACILITY NUMBER:
197608349
ADMINISTRATOR:MARINE KARAPETIANFACILITY TYPE:
740
ADDRESS:14132 HUBBARD STREETTELEPHONE:
(818) 837-0077
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:78CENSUS: 52DATE:
07/02/2021
UNANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:Gigi Sumulong - Assistant AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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(This is an amendment of the report issued on 07/02/21 to remove the other allegation)

Facility emergency alarms are disabled
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Assistant Administrator Gigi Sumulong and explained the reason for the visit.

LPA conducted physical plant tour at 9:25 AM. At 9:50, LPA requested copy of pertinent documents relevant to the investigation. At 11:25 AM, LPA interviewed the assistant administrator. Regarding the allegation that the facility emergency alarms are disabled, LPA physical plant tour at 9:35 AM revealed that the auditory alarm for the emergency exit is working properly. The alarm is equipped with motion sensor. LPA interview with assistant administrator at 11:25 AM revealed that due to constant use by the residents who smoke at the back alley, the battery always ran out and had to be replaced constantly. LPA observation revealed that the emergency auditory alarm is part of a redundant security system as it also has a CCTV system monitoring the residents. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.
Exit interview conducted. Copy of this report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 31-AS-20210628093855
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ABBEY ROAD VILLA
FACILITY NUMBER: 197608349
VISIT DATE: 07/02/2021
NARRATIVE
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(continued from LIC 9099)
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3