197608349-5-12-2022-31-AS-CHAS-CERRXS-20220525132514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 05/12/2022
Date Signed: 05/12/2022 01:09:15 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
12/17/2021 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20211217091705

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: 58	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Gigi Sumulong		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Resident is being mistreated while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit to deliver the final findings of the allegation mentioned above. LPA met with Assistant Administrator Gigi Sumulong, and the following was determined:

It was alleged that resident #1 (R1) was being mistreated while in care. On 12/22/2021 from 930am to 12pm, LPA Gary Tan, conducted the initial visit, gathered documents, interviewed residents and R1. On 05/09/2022, LPA Tuesday re-reviewed the complaint and documents received regarding the allegation. During today's visit, from 12pm to 1pm, LPA Tuesday conducted additional interviews with residents and R1. From the interviews, it was reported to LPAs from R1, who denied being mistreated or verbally abused while in care. It was also revealed from other residents, that they are not being mistreated, and were comfortable living at the facility. Therefore, based on interviews, the allegation "Resident is being mistreated while in care", is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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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