197608760-10-23-2024-29-AS-KLOZ-DAHSZQ-20241029141931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608760
Report Date: 10/23/2024
Date Signed: 10/23/2024 01:23:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2024 and conducted by Evaluator Trevor Byrne

COMPLAINT CONTROL NUMBER: 29-AS-20241017092856

FACILITY NAME:	NOBLE CARE		FACILITY NUMBER:	197608760
ADMINISTRATOR:	ARMINE TAGARYAN		FACILITY TYPE:	740
ADDRESS:	13300 ARMINTA STREET		TELEPHONE:	(818) 616-2427
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 4	DATE:	10/23/2024
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Armine Tagaryan		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff do not properly feed resident in care.
Staff do not ensure resident is provided fluids.
Staff leave resident in bed for extended periods of time.
Staff isolates resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 09:04 AM. LPA met with the facility Administrator Armine Tagaryan the reason for the visit was explained and entrance interview was conducted.

During today’s visit LPA conducted a physical plant tour, interviewed residents, interviewed facility staff, interviewed the facility Administrator and conducted file review between 09:05 AM and 11:36 AM.

The allegation of “Staff do not properly feed resident in care” alleges that facility staff do not provide enough food to Resident #1 (R1) to meet their dietary needs. LPA conducted a physical plant tour of the facility and observed the facility’s pantry and refrigerator to be fully stocked. LPA observed a sufficient supply of two (2) days perishable and seven (7) days non-perishable food.

Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

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 29-AS-20241017092856

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: NOBLE CARE	FACILITY NUMBER: 197608760
	VISIT DATE: 10/23/2024

NARRATIVE

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At 09:05 AM LPA observed facility staff delivering breakfast to residents in care. R1’s family member (Witness #1) was interviewed via telephone call. W1 had no concerns with the amount or quality of food being served to R1. LPA interviewed Staff #1 (S1). S1 stated that residents get three (3) meals a day with snacks in between if requested, S1 has never denied a request from a resident for additional food. LPA reviewed R1’s medical records which contained no information to indicate malnutrition. LPA interviewed R1 who stated that they get enough food. Based on the information obtained during the physical plant tour, record review, and interviews there is not sufficient evidence to support the allegation of Staff do not properly feed resident in care. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

The allegation of “Staff do not ensure resident is provided fluids” alleges that facility staff do not ensure that R1 is provided with a sufficient amount of fluids. During the physical plant tour LPA observed the refrigerator to be stocked with juices and other drinks. LPA interviewed R1 who stated that they get enough juice when they ask. LPA interviewed Resident #2 (R2) and Resident #3 (R3). Both residents stated that they receive enough fluids and that drinks are provided by staff when requested. During breakfast LPA observed the trays to contain juice and/or coffee. During S1’s interview they confirmed that residents are provided with liquids when requested. Based on the information obtained during the physical plant tour and interviews there is not sufficient evidence to support the allegation of Staff do not properly feed resident in care. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

The allegation of “Staff leave resident in bed for extended periods of time” alleges that facility staff do not move R1 from their bed for extended periods of time. During the physical plant tour LPA observed R1 in their bed. The facility Administrator approached R1 to introduce LPA prior to the interview. The facility Administrator attempted to move R1’s arm and R1 exclaimed, “Don’t move me!” LPA then interviewed R1 who stated that they do not like to be moved. R1 stated that they wish facility staff would leave their head alone as they do not like it when staff attempt to reposition their neck. LPA asked R1 if they ever ask staff to take them out of bed and R1 replied, “I don’t want to get out of bed.”

Continued on LIC 9099C.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241017092856

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: NOBLE CARE	FACILITY NUMBER: 197608760
	VISIT DATE: 10/23/2024

NARRATIVE

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LPA spoke with W1, they stated that they wished R1 would be moved more but they expressed understanding that R1 does not wish to be moved and stated that they know movement causes R1 pain. During LPAs interview with S1 they stated that R1 has never asked them to be moved from the bed. S1 confirmed that they reposition R1 in bed every three (3) hours. LPA interviewed the facility Administrator, they confirmed that R1 does not like being moved. The Administrator stated that in the past they have moved R1 from their bed to a recliner located in the living room via Hoyer lift. R1 would only sit in the chair for a minute before requesting to be placed back in their bed due to pain. The Administrator stated that R1 complains every time they attempt to move or reposition them. R2 is R1’s roommate. R2 stated that they have observed facility staff attempting to move R1 in the past. R2 stated that R1 tells facility staff not to move them often. Based on the information obtained during observation and interviews there is not sufficient evidence to support the allegation of Staff leave resident in bed for extended periods of time. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

The allegation of “Staff isolates resident in care” alleges that facility staff isolate R1 for extended periods of time. During the investigation LPA observed facility staff attending to R1 and other resident’s needs. LPA interviewed R1 who stated that their family is allowed to visit them. R1 stated that facility staff attend to them enough to take care of them. During the interviews with R2 and R3 both residents stated that the facility staff are kind and attentive to their needs. Neither resident had concerns about being isolated. S1 stated during their interview that they attend to all residents throughout the day and respond to resident requests quickly when called. The facility Administrator denied isolating the resident. The Administrator stated that they respond to the resident’s requests when asked and they allow family to visit whenever they want. W1 has never been denied from visiting R1 and did not express any concerns about R1 being isolated. Based on the information obtained during interviews there is not sufficient evidence to support the allegation of Staff isolates resident in care. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

No deficiencies were cited during today’s investigation. A copy of the report was printed and exit interview was conducted.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC9099 (FAS) - (06/04)

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