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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609604
Report Date: 06/30/2022
Date Signed: 06/30/2022 03:02:23 PM

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
09/23/2021 and conducted by Evaluator Salia Walker
COMPLAINT CONTROL NUMBER: 29-AS-20210923141341
FACILITY NAME:HM SWEET HOMEFACILITY NUMBER:
197609604
ADMINISTRATOR:NADRIAN, ASMIKFACILITY TYPE:
740
ADDRESS:6215 BLUEBELL AVENUETELEPHONE:
(818) 903-6302
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 5DATE:
06/30/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Anahit HovhannisyanTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Caregiver is rude to resident #1 (R1).
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint visit for the above allegation. Upon entry, the LPA was greeted by staff. At 12:36 p.m., the LPA contacted Administrator Asmik Nadrian, and explained the reason for the visit.

On 09/28/2021, LPA Salia Walker conducted an unannounced initial 10-day complaint inspection. During the visit, the LPA conducted a physical plant tour from 3:56 p.m. until 4:03 p.m. From 4:05 p.m. until 4:25 p.m., the LPA reviewed and obtained copies of documents pertinent to the investigation. From 4:25 p.m. until 4:45 p.m., the LPA conducted an interview with the administrator. The LPA determined further investigation was required at that time.

Continue on LIC9099C..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
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
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
09/23/2021 and conducted by Evaluator Salia Walker
COMPLAINT CONTROL NUMBER: 29-AS-20210923141341

FACILITY NAME:HM SWEET HOMEFACILITY NUMBER:
197609604
ADMINISTRATOR:NADRIAN, ASMIKFACILITY TYPE:
740
ADDRESS:6215 BLUEBELL AVENUETELEPHONE:
(818) 903-6302
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 5DATE:
06/30/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Anahit HovhannisyanTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Caregiver will not assist the resident #1 (R1) to leave R1's room.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint visit for the above allegation. Upon entry, the LPA was greeted by staff. At 12:36 p.m., the LPA contacted Administrator Asmik Nadrian, and explained the reason for the visit.

On 09/28/2021, LPA Walker conducted an unannounced initial 10-day complaint inspection. During the visit, the LPA conducted a physical plant tour from 3:56 p.m. until 4:03 p.m. From 4:05 p.m. until 4:25 p.m., the LPA reviewed and obtained copies of documents pertinent to the investigation. From 4:25 p.m. until 4:45 p.m., the LPA conducted an interview with the administrator. The LPA determined further investigation was required at that time.

Continue on LIC9099C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20210923141341
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: HM SWEET HOME
FACILITY NUMBER: 197609604
VISIT DATE: 06/30/2022
NARRATIVE
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On 06/22/2022, LPA Walker arrived unannounced for a subsequent complaint visit. During the visit, the LPA conducted a physical plant tour with staff at 9:20 a.m. From 9:30 a.m. until 10:00 a.m., the LPA reviewed seven (7) out of seven (7) resident files. From 10:10 a.m. until 11:30 a.m., the LPA conducted interviews with five (5) out of six (6) facility residents. The LPA determined further investigation was required at that time.

During today’s visit, the LPA conducted interviews with facility staff from 1:30 p.m. until 2:00 p.m.

Regarding the allegation, ‘Caregiver will not assist the resident #1 (R1) to leave R1's room,’ the complainant’s concern is that R1 has to stay in their room all day because the caregivers will not assist R1 in going outside.

During the investigation, the LPA conducted interviews with the Administrator, R1, facility residents, resident family members, and facility staff. Interview with the Administrator revealed that R1 would move around the facility with the use of their wheelchair. Interview with the Administrator also revealed that R1 ‘liked being in [R1’s] room.’ Interview with R1 revealed that they do not require assistance transferring in and out of bed, and they are ‘able to do it [themselves].’ Interview with R1 also revealed that R1 would leave their room ‘every other day,’ and ‘would hang out in the back yard.’ R1 also stated that they are able to get up, and transfer into their wheelchair without assistance. Interviews with facility residents revealed that they have observed R1 leaving R1’s room in R1’s wheelchair. Interviews with residents also revealed that R1 would be ‘in the backyard’ at times. Interviews with resident family members revealed that R1 was observed ‘out in the patio’ during a visit. Interviews with facility staff revealed that R1 would leave R1’s room approximately ‘4 to 5 times weekly,’ if not ‘every day.’ Interviews with facility staff also revealed that R1 ‘liked to sit in the living room, and go outside where [R1] would listen to music or read books.’

Based on interviews which were conducted, there is insufficient evidence to support the allegation ‘Caregiver will not assist the resident #1 (R1) to leave R1's room.’ 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 via telephone with Administrator Asmik Nadrian at 2:40 p.m. A copy of the report was issued.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20210923141341
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: HM SWEET HOME
FACILITY NUMBER: 197609604
VISIT DATE: 06/30/2022
NARRATIVE
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On 06/22/2022, LPA Walker arrived unannounced for a subsequent complaint visit. During the visit, the LPA conducted a physical plant tour with staff at 9:20 a.m. From 9:30 a.m. until 10:00 a.m., the LPA reviewed seven (7) out of seven (7) resident files. From 10:10 a.m. until 11:30 a.m., the LPA conducted interviews with five (5) out of six (6) facility residents. The LPA determined further investigation was required at that time.

During today’s visit, the LPA conducted interviews with facility staff from 1:30 p.m. until 2:00 p.m.

Regarding the allegation, ‘Caregiver is rude to resident #1 (R1),’ the complainant’s concern is that R1 is not being accorded with dignity by facility staff, as they observed the facility staff being rude and mean to R1 during a visit.

During the investigation, the LPA interviewed facility staff who denied the allegation. In addition, the Administrator denied the allegation as well. However, the LPA also conducted interviews with the complainant, facility residents, and resident family members who all confirmed that they have observed staff being rude to R1. Interviews revealed that staff were observed speaking to R1 ‘very condescending saying things like ‘we told you no!’ Interviews also revealed that staff ‘yell,’ and say things such as ‘you have to eat!’ Additionally, interviews revealed that facility staff have yelled ‘shut up!’ to R1.

Based on interviews which were conducted, and the preponderance of evidence, there is sufficient evidence to support the allegation ‘Caregiver is rude to resident #1 (R1).’ Therefore, the above allegation is found to be Substantiated at this time.

Pursuant to Title 22 of the California Code of Regulations, the following deficiency was cited (refer to LIC 9099D). Exit interview conducted via telephone with Administrator Asmik Nadrian at 2:40 p.m. A copy of the report, and appeal rights were issued.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20210923141341
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: HM SWEET HOME
FACILITY NUMBER: 197609604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2022
Section Cited
CCR
87468.1(a)(1)
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87468.1(a)(1) Personal Rights of Residents in All Facilities (a) Residents in all residential care
facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement is not met as evidenced by:
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The Licensee has agreed to do the following:
1. Provide staff training on personal rights, and how to treat residents with dignity and respect. 2.Submit proof of staff training to CCL by 07/01/22.
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Based on interviews conducted, the licensee failed to ensure that R1 was accorded with dignity in their personal relationships with residents, and other persons, which posed an immediate safety and 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.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5