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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609307
Report Date: 05/27/2022
Date Signed: 05/27/2022 10:07:48 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
03/16/2022 and conducted by Evaluator Salia Walker
COMPLAINT CONTROL NUMBER: 29-AS-20220316162717
FACILITY NAME:WELLBE HOMEFACILITY NUMBER:
197609307
ADMINISTRATOR:MKRTCHIAN, VAHEFACILITY TYPE:
740
ADDRESS:12936 WELBY WAYTELEPHONE:
(818) 414-0005
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:4CENSUS: 4DATE:
05/27/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lala KarapetyanTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Failure to contain records of resident's cash resources as specified
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Salia Walker arrived unannounced to deliver the findings for the above allegation. Upon entry, the LPA was greeted by staff. At 9:19 a.m., the LPA contacted Administrator Vahe Mkrtchian, and entrance interview was conducted.

On 03/23/22, LPA Walker conducted an unannounced initial complaint inspection. During the visit, the LPA conducted a physical plant tour with the administrator. From 11:27 a.m. until 11:55 a.m., the LPA conducted an interview with the administrator. From 11:55 a.m. until 12:37 p.m., the LPA reviewed and obtained copies of documents pertinent to the investigation. From 12:37 p.m. until 1:55 p.m., the LPA along with the Administrator reviewed four (4) out of four (4) client medications. From 2:08 p.m. until 2:46 p.m., the LPA conducted interviews with three (3) out of four (4) facility clients. From 2:46 p.m. until 2:56 p.m., the LPA conducted interviews with staff. The LPA determined further investigation was needed at that time.
Continue on LIC9099C..
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
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 5
Control Number 29-AS-20220316162717
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: WELLBE HOME
FACILITY NUMBER: 197609307
VISIT DATE: 05/27/2022
NARRATIVE
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Regarding the allegation, ‘Failure to contain records of resident's cash resources as specified,’ it is alleged that the facility failed to update clients’ P and I files since October 2021.

On 03/16/22, interview(s) revealed that an outside agency credible witness visited the facility; and during the visit, the Administrator provided receipts, and advised that the facility would be updating the clients P and I’s as the facility fell behind.

During the investigation, LPA Walker conducted a record review, and interview with the administrator. Record review revealed that three (3) out of four (4) client P and I files were up to date. Record review also revealed that client purchase receipts were accurate, and numbered. Interview with the Administrator revealed that facility client’s cash resources in the P and I book had not been updated for a few months. The administrator acknowledged the facility failed to follow regulation and keep clients P and I’s updated, as they ‘got busy, and fell behind.’ The Administrator also stated that the facility has since then implemented the suggested record keeping order from Regional Center since the last visit.

Based on record review and interviews which were conducted, there is sufficient evidence to support the allegation ‘Failure to contain records of resident's cash resources as specified.’ Therefore, the above allegation is found to be Substantiated at this time.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D). Exit interview conducted, today's reports and appeal rights were reviewed and issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20220316162717
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: WELLBE HOME
FACILITY NUMBER: 197609307
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2022
Section Cited
CCR
80026(h)
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80026(h) Safeguards for Cash Resources, Personal Property, and Valuables of Residents (h) Each licensee shall maintain accurate records of accounts of cash resources... entrusted to his/her care, including, but not limited to the following:
This requirement was not met as evidenced by:
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The Licensee agreed to the following:
1.Submit a statement of understanding of section 80026(h) to CCL by 06/03/22.
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Based on interviews conducted, the licensee did not comply with the section cited above, as the facility failed to ensure clients P and I records were up to date, which poses a potential personal rights 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.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/16/2022 and conducted by Evaluator Salia Walker
COMPLAINT CONTROL NUMBER: 29-AS-20220316162717

FACILITY NAME:WELLBE HOMEFACILITY NUMBER:
197609307
ADMINISTRATOR:MKRTCHIAN, VAHEFACILITY TYPE:
740
ADDRESS:12936 WELBY WAYTELEPHONE:
(818) 414-0005
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:4CENSUS: 4DATE:
05/27/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lala KarapetyanTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff did not assist resident with self-administered medications as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Salia Walker arrived unannounced to deliver the findings for the above allegation. Upon entry, the LPA was greeted by staff. At 9:19 a.m., the LPA contacted Administrator Vahe Mkrtchian, and entrance interview was conducted.

On 03/23/22, LPA Walker conducted an unannounced initial complaint inspection. During the visit, the LPA conducted a physical plant tour with the administrator. From 11:27 a.m. until 11:55 a.m., the LPA conducted an interview with the administrator. From 11:55 a.m. until 12:37 p.m., the LPA reviewed and obtained copies of documents pertinent to the investigation. From 12:37 p.m. until 1:55 p.m., the LPA along with the Administrator reviewed four (4) out of four (4) client medications. From 2:08 p.m. until 2:46 p.m., the LPA conducted interviews with three (3) out of four (4) facility clients. From 2:46 p.m. until 2:56 p.m., the LPA conducted interviews with staff. The LPA determined further investigation was needed at that time.
Continue on LIC9099C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20220316162717
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: WELLBE HOME
FACILITY NUMBER: 197609307
VISIT DATE: 05/27/2022
NARRATIVE
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Regarding the allegation, ‘Staff did not assist residents with self-administered medications as prescribed,’ it is alleged that facility clients’ medication count was off. It was also alleged that the facility staff did not have a sequence in which medication bubble packs were distributed. Therefore, there was concern that clients were not being assisted with the self-administration of medication as prescribed.

On 03/16/22, interview(s) revealed that an outside agency credible witness visited the facility; and during the visit, three (3) out of four (4) client medications were reviewed. The interview(s) also revealed that during the medication review, there was no sequence in the bubble packs for the three (3) clients. Credible witness also noted the facility started backwards from the end of the month, and on the 20th for one month there was one (1) pill that was not punched. According to the credible witness, the explanation that was given was that the facility received a ‘new batch’ on the 27th. However, the credible witness could not confirm, as allegedly the medication count was still off.

During the investigation, LPA Walker conducted interviews with the administrator, facility clients, staff, and conducted a medication audit. Interview with the administrator revealed that all clients are assisted with the self-administration of their medication on time. The administrator admitted to not having a set sequence in which the medication bubble packs were ‘popped.’ However, denied any medication being missed or staff not assisting clients with self-administered medications as prescribed. Interviews with facility staff revealed that no medication has been forgotten to be provided to clients. Interviews with facility clients revealed that staff have not forgotten to assist clients with self-administration of their medication. Interviews with facility clients also revealed that staff are ‘timely;’ and if staff are running behind due to cooking during lunch, clients remind them within ‘5 minutes.’ Medication audit conducted by LPA Walker along with Administrator Vahe Mkrtchian revealed that four (4) out of four (4) client medications were accurate, and accounted for.

Based on record review, interviews with the administrator, facility staff, and clients, although there may have been times when client’s medication bubble packed were popped out of sequence. The facility staff have been retrained in following a sequence, and no medication was missing. Therefore, there is insufficient evidence to support the allegation ‘Staff did not assist residents with self-administered medications as prescribed.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.
No deficiencies cited. Exit interview conducted and a copy of the report was emailed.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5