197609020-9-20-2022-29-AS-KHEN-CJNQCD-20220927120257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609020
Report Date: 09/20/2022
Date Signed: 09/20/2022 04:59:53 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
06/18/2020 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20200618143126

FACILITY NAME:	COMFORT ELDERLY CARE, INC.		FACILITY NUMBER:	197609020
ADMINISTRATOR:	MAKHTESYAN, DIANA		FACILITY TYPE:	740
ADDRESS:	6701 CANTALOUPE AVE		TELEPHONE:	(818) 602-1622
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	0	CENSUS: 0	DATE:	09/20/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Diana Makhtesyan		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff do not prevent residents from wandering away from the facility.
Staff speak inappropriately to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted a subsequent telephonic complaint visit for the purpose to deliver findings for the above allegations. At 9:39 a.m., LPA Peraldi attempted to call Licensee, Diana Makhtesyan and left a voicemail.

During the initial visit, conducted virtually to implement mitigation measures related the Coronavirus Disease 2019 (COVID-19) on 06/25/2020 at 12:45 p.m., LPA Aja Richardson interviewed the Licensee, Diana Makhtesyan and requested pertinent files and documents. On 11/04/2021, LPA Emily Peraldi conducted a subsequent complaint visit at Licensee’s new facility location, COMFORT ELDERLY CARE # 195850162. During the subsequent visit, LPA Peraldi conducted a physical plant tour and removed Resident #1 (R1) records and returned records within three business days. Additionally, on 11/04/2021, LPA Peraldi interviewed the new Administrator at COMFORT ELDERLY CARE # 195850162.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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-20200618143126

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: COMFORT ELDERLY CARE, INC.	FACILITY NUMBER: 197609020
	VISIT DATE: 09/20/2022

NARRATIVE

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Regarding the allegations: Staff do not prevent residents from wandering away from the facility. Staff speak inappropriately to residents.
On 06/18/2020, the Department received a complaint in which it was alleged that the facility staff did not properly supervise residents which led to residents leaving the facility without the knowledge of the staff. It was also alleged that staff spoke to residents inappropriately. Interview conducted on 06/25/2020, with the Licensee revealed that at the time of the complaint, the facility had six (6) residents and two (2) staff. No further information was provided during the interview. On 11/04/2021 at 5:33 p.m., LPA Peraldi attempted to call the Licensee and left a voicemail. On 11/04/2021, LPA Peraldi interviewed the new Administrator. The Administrator stated that they started working at COMFORT ELDERLY CARE # 195850162 three months prior in September 2021 and did not have information regarding the allegations above. On 09/17/2022, LPA Peraldi reviewed all available documents and interviews obtained during the previous investigations. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated.

Exit interview conducted. A copy of the report was issued to the former Licensee via mail for signature and email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC9099 (FAS) - (06/04)

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