197608972-5-18-2023-29-AS-DPEA-CSBMZU-20230530100344

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608972
Report Date: 05/18/2023
Date Signed: 05/18/2023 05:55:31 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/04/2021 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20211004144804

FACILITY NAME:	ANTHEM SENIOR CARE		FACILITY NUMBER:	197608972
ADMINISTRATOR:	GHAZARYAN, SOFIA		FACILITY TYPE:	740
ADDRESS:	12813 FRIAR STREET		TELEPHONE:	(818) 445-0993
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 5	DATE:	05/18/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Sofia Ghazaryan		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff slapped resident; Staff spoke inappropriately to resident
Staff opened resident's personal mail
Staff made resident give staff access to resident's finances
Staff impersonated resident on phone calls
Staff does not provide a good quality of food
Staff does not provide an adequate quantity of food
Staff does not follow resident's prescribed diet
Staff did not dispense resident's medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver final investigation finding regarding above allegations.

Following is a summary of the investigation:
On 10/04/2021, the Department received allegations list above. On 10/12/202, LPA Salia Walker conducted an unannounced complaint visit to the facility. From 9:44 a.m. to 2 p.m., LPA Salia Walker conducted interviews with the administrator, facility residents and other potential witnesses. Administrator denied all allegations. Four out of five residents interviewed reported no mistreatment by any staff, no issues with receiving their mail and no situation with staff accessing residents personal finances. Resident interviewed could not recall if their mail was opened or not. Staff denied allegation of impersonating any resident on phone calls. Four out five resident interviewed were not aware of any staff impersonating resident on phone calls. Regarding allegation staff did not dispense resident’s medication as prescribed– (continue to LIC9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

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 29-AS-20211004144804

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ANTHEM SENIOR CARE	FACILITY NUMBER: 197608972
	VISIT DATE: 05/18/2023

NARRATIVE

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Five (5) out of five (5) residents interviewed did not express any issues with their medication. Resident records reviewed revealed only one resident on puree diet and no other residents on any set prescribed diet. Four out of five residents interviewed expressed the facility food quality is good. Facility food supply observed sufficient during initial visit on 10/12/2021 visit. A potential witness was interviewed during initial visit on 10/12/2021 by LPA Salia Walker. This witness did not have any issues or complaints to report.

LPA Salia Walker attempt to gather details from reporting parties to support allegations however no additional information was provided. Date and time of alleged allegations could not be confirmed.

During todays visit LPA Chochian conducted a physical plant tour from 1:20pm to 1:40pm. During the tour LPA observed three (3) refrigerators all of which observed stocked with fruits, vegetables, meats, poultry, and fish. Between 1:45pm to 2:30pm LPA Chochian conducted and interview with residents, staff and other potential witness. Resident interviewed expressed liking the facility and report no mistreatment. Feels safe at the facility; no issues with medications; likes the food; no issues with receiving unopened mail; no staff impersonating any resident on the phone and reported receiving medications regularly with no issues. Other potential witness interviewed during todays visit expressed being satisfied with the care provided by staff; the quality and quantity of the facility food supply. This witness has not observed any physical, verbal or financial mistreatment. At the time

Based on the information gathered during the course of investigation, there is not enough evidence to support any of the allegations in this report. Therefore, allegations are deemed unsubstantiated at this time.

Exit interview held, copy of report provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

LIC9099 (FAS) - (06/04)

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