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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609006
Report Date: 11/16/2021
Date Signed: 11/17/2021 10:44:57 AM

Substantiated


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
11/09/2021 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20211109122722
FACILITY NAME:VICTORY PLACE HOMEFACILITY NUMBER:
197609006
ADMINISTRATOR:AKHPARIAN, ANDREWFACILITY TYPE:
735
ADDRESS:6353 BABCOCK AVETELEPHONE:
(818) 585-0095
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:4CENSUS: 4DATE:
11/16/2021
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Andrew AkhparianTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Client was left unattended while in care
Staff do not properly maintain the clients’ rooms while in care
Facility gate is in disrepair
INVESTIGATION FINDINGS:
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On 11/16/2021, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day complaint investigation regarding the above allegations. The LPA was greeted by the Caregiver, Diana Gevorgyan. The caregiver called the Licensee, Andrew Akhparian, who was in the back of the residence in their apartment. LPA Urena met with the licensee at 2:15 pm and explained the reason for the visit.
On 11/12/2021, at 10:45 am, the LPA spoke with a credible witness regarding the allegations. On 11/16/2021 at 2:25pm, the LPA toured the facility, inside and outside. The LPA interviewed staff at 2:40pm.
Regarding the allegation: Client was left unattended while in care
It is alleged that the client was left unsupervised while in care at the facility. Client #1(C1) was found to be home without a staff present inside the dwelling. C1 had arrived at the home from the community and no staff was present in the home. LPA Urena interviewed Staff #1(S1), who confirmed that S1 was not in the dwelling when C1 arrived from the community. The LPA also interviewed a credible witness who confirmed that the resident was left unattended without staff presence on November 8, 2021. Therefore, the above allegation(s) is found to be SUBSTANTIATED at this time. Please see LIC 9099D.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 29-AS-20211109122722
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: VICTORY PLACE HOME
FACILITY NUMBER: 197609006
VISIT DATE: 11/16/2021
NARRATIVE
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Regarding the allegation: Staff do not properly maintain the clients’ rooms while in care

It is alleged that the facility staff do not properly clean clients’ rooms while in care. On November 8, 2021, a credible witness observed that four bedrooms’ floors had debris fields throughout. Clients interviewed during the visit indicated that they were comfortable having staff vacuum and mop the floors daily. Clients bedroom closet mirrors were also observed to be dirty. Additionally, it was found that the clients’ primary bathroom was also not cleaned, nor sanitized following the residents’ morning use. The LPA toured the facility today and interviewed staff, clients and the administrator. There was confirmation that the physical plant was not up to standard on November 8, 2021. Therefore, the above allegation is found to be SUBSTANTIATED at this time. Please see LIC 9099D.



Regarding the allegation: Facility gate is in disrepair

It is alleged that the side gate leading to the apartment in the rear of the property was leaning significantly and poses as a serious safety risk to clients at the facility. During today’s visit and interview with the Licensee, LPA Urena learned that the side gate was indeed in need of repair. Repair of the gate had expected to happen, but was not done in a timely manner. The wooden gate was removed and replaced with a new metal gate as of 11/09/2021. Based on interviews with credible witnesses, this allegation is deemed to be Substantiated at this time. Please see LIC 9099D.



Exit interview was conducted, and the report was reviewed with the licensee. Citations, and appeal rights were issued. Copy of the report was emailed to Licensee.


SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 29-AS-20211109122722
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: VICTORY PLACE HOME
FACILITY NUMBER: 197609006
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/29/2021
Section Cited
CCR
80087(a)
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80078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client’s needs. The requirement was not met as evidenced by:
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POC: The licensee shall develop a plan to ensure that staff are always present when client’s return back home from their activities out of home; and then, provide training on this plan to all staff by November 26, 2021. Submit the plan to CCL by November 19, 2021.
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Based on interviews and a credible witness, Client #1 (C1) was left unsupervised on November 8, 2021, which posed an immediate health and safety risk to residents in care.
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Type B
11/16/2021
Section Cited
CCR
80087(a)
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80087 Building and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by:
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POC: Upon today’s visit, the client bedroom floors and closet mirrors have been cleaned, as well as the client’s primary bathroom. Therefore, the POC has been cleared today.
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Based on interviews and observation of a credible witness, the client bedroom floors had debris fields, throughout; two client bedroom closet mirrors were dirty and the client’s primary bathroom was also not cleaned and sanitized after the morning use, which posed a health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20211109122722
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: VICTORY PLACE HOME
FACILITY NUMBER: 197609006
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2021
Section Cited
CCR
80087(a)
1
2
3
4
5
6
7

80087 Building and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by:
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Upon today’s visit, the gate has been repaired. POC cleared.
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Based on interviews and observation, the side gate leading to the apartment in the rear of the property was leaning significantly, which posed an immediate health and safety to risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4