197608711-4-14-2023-31-AS-NMAN-CRFVED-20230502162210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608711
Report Date: 04/14/2023
Date Signed: 04/14/2023 12:07:42 PM

Unfounded

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
04/13/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230413110851

FACILITY NAME:	FOOTHILL RETIREMENT CARE HOME		FACILITY NUMBER:	197608711
ADMINISTRATOR:	JINA MALEKSARKISSIANS		FACILITY TYPE:	740
ADDRESS:	6720 SAINT ESTEBAN STREET		TELEPHONE:	(818) 353-3350
CITY:	TUJUNGA	STATE: CA	ZIP CODE:	91042
CAPACITY:	72	CENSUS: 41	DATE:	04/14/2023
		UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Jecery Ninonuevo - Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff yelled at resident
Facility staff illegally evicted resident
Facility did not issue a refund
Facility TV is in disrepair
Residents are left unsupervised for a long period of time
Facility staff did not respond to resident’s call for help.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Administrator Jecery Ninonuevo and explained the reason for the visit.

LPA conducted physical plant tour at 10:00 AM, requested copy of facility documents relevant to the investigation at 10:30 AM and interviewed administrator at 11:00 AM. LPA's interview with the administrator revealed that the supposed owner mentioned in the complaint has no connection at this facility whatsoever and there was no staff working at this facility also mentioned in the complaint. Based on the information gathered during this visit, the allegations are deemed unfounded at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. Copy of this report issued.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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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