197608678-10-3-2023-31-AS-NGID-CWVTDH-20231023143820

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608678
Report Date: 10/03/2023
Date Signed: 10/03/2023 02:18:20 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
09/26/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230926084656

FACILITY NAME:	HARTLAND CARE, INC.		FACILITY NUMBER:	197608678
ADMINISTRATOR:	ANI MAKARYAN		FACILITY TYPE:	740
ADDRESS:	8224 ZELZAH AVENUE		TELEPHONE:	(818) 697-5363
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 4	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Dianna Makaryan, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Residents are not being showered
Staff physically abuses the resident in care
Facility financially abused resident in care.

INVESTIGATION FINDINGS:

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At 10:00am, Licensing Program Analysts (LPAs) Angela Panushkina, Leslie Ngo-Castaneda and Huma Rahimi conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPAs met with Reuel Staff #1 (S1), who granted access to the facility. Administrator arrived shortly after and LPAs explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 10:10am, LPAs requested resident and staff roster. At 10:20am, LPAs requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, etc., relevant to the investigation. However, only facility Admission Agreement and former Admission Records from Santa Paula Hospital, for R1, were available. At approximately 10:30am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:40am – 12:10pm, LPA interviewed the Administrator, two (2) staff and four (4) residents and two Assisted Living Waver (ALW) Social Workers. Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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-20230926084656

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: HARTLAND CARE, INC.	FACILITY NUMBER: 197608678
	VISIT DATE: 10/03/2023

NARRATIVE

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Allegation: Residents are not being showered
It is alleged that staff do not provide showers to residents on a regular basis. To investigate this allegation, LPAs conducted an interview with two (2) out of four (4) residents, who was able to communicate, and were informed that the facility provides showers and they had no concerns regarding this allegation. In addition, LPAs observed all four (4) residents appeared to be clean, well groomed and well taken care of. Moreover, interviews with the Administrator and two (2) staff members revealed that the facility provides showers at least twice a week or as needed. In addition, review of records also revealed that three (3) out of four (4) residents receive hospice services and are scheduled to have two (2) showers weekly and one (1) resident is being provided two (2) showers weekly by the Home Health Agency aid.

Allegation: Staff physically abuses the resident in care

It is alleged that a facility caregiver abuses other residents by slapping them on their hands. LPAs conducted an interview with two (2) out of four (4) residents, who were able to communicate, and were informed that the facility staff are nice and take good care of them. Moreover, LPAs conducted an interview with the Administrator and two (2) staff members and all denied the allegation and reported no resident ever complained being physically abused. Lastly, LPA Panushkina interviewed two (2) Social Workers over the phone and both informed LPA that they've visited this facility numerous times and never witnessed any staff members physically abusing residents.

Allegation: Facility financially abused resident in care
It was alleged that facility financially abused resident (R1) in care. LPAs conducted an interview with two (2) out of four (4) residents, who were able to communicate and were informed that the facility has no access to their finances and their family take care of everything for them. In addition, LPAs conducted an interview with the Administrator and two (2) staff members and all denied ever having access to R1's or other residents' finances/bank accounts. LPAs were also informed by the Administrator that R1 purchased a lot of cannabis. Moreover, interview with two (2) social workers confirmed that due to R1's drug use in the past, R1 spend majority of his/her money to buy edibles/cannabis.

Based on inspection, observation and interviews there is no sufficient evidence to support the allegation. Therefore, all allegations are Unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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