197609604-6-19-2024-29-AS-KHEN-D6N7E2-20240627213514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609604
Report Date: 06/19/2024
Date Signed: 06/19/2024 12:32:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
11/07/2023 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20231107095933

FACILITY NAME:	HM SWEET HOME		FACILITY NUMBER:	197609604
ADMINISTRATOR:	NADRIAN, ASMIK		FACILITY TYPE:	740
ADDRESS:	6215 BLUEBELL AVENUE		TELEPHONE:	(818) 903-6302
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 6	DATE:	06/19/2024
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Mariam Baghdoyan, Staff		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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2. Staff coerced Resident's Representative into enrolling resident into hospice.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent complaint visit to deliver the findings for the above allegation. During today’s visit, LPA Yee met with Mariam Baghdoyan, Staff. Asmik Nadrian, Administrator was contacted and was not in the local vicinity and did not participate in today's visit. LPA Yee explained to the Administrator, the reason for the visit today andauthorized staff to sign the documents.

On 11/07/2023, the Department received a complaint regarding an allegation that Staff coerced Resident's Representative(RR) into enrolling resident into hospice. This allegation was investigated by LPA Christine Yee

On 11/8/23, Licensing Program Analyst (LPA)Christine Yee conducted an unannounced intial complaint visit in conjunction with a health and safety visiit and was let into the home by Mariam Baghdoyan, Caregiver.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

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 3

Control Number 29-AS-20231107095933

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HM SWEET HOME	FACILITY NUMBER: 197609604
	VISIT DATE: 06/19/2024

NARRATIVE

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Also present on today's visit was Emilya Hovsepyan, Caregiver. Ashmik Nadrian, Administrator/Licensee was contacted by staff and was not reachable via phone and did not participate in today's visit. The faciliity also did not have evidence of a designated responsible staff when the Administrator is not present at the facility.During the visit conducted on 11/8/23, LPA Yee toured the facility at 1:15pm, reviewed the food supply at 1:30pm and observed the 4 residents in care at 1:40pm and reviewed 6 resident files at 10:30am. Copies of files for Resident #1 and Resident #6 were obtained. No interviews were conducted as staff present had no information or spoke very limited English. They also stated that they are just caregivers.

Per tour of the facility on 11/8/23, inside and outside, no immediate safety concerns were observed for the physical plant Perishable and non-perishable foods were reviewed. Sufficient perishable foods for 2 days were observed and non-perishable foods for 7 days were observed but additional canned protein goods need to be supplemented for a balanced meal, utilities were observed to be in use, the four residents in care, were visually observed to be in bed in their rooms and doing well. Marine Arshakyan, Administrator arrived around 1:20pm. Per Marine she became co-Administrator about 6 years ago.
Based on the visit conducted on 11/8/23, it was determined that further investigation is needed to make a finding for the above allegations. Exit interview was conducted with Marine Arshakyan, Staff.

Per interview conducted with the resident representative at 11:21am on 6/18/24, regarding the allegation that staff coerced resident representative into enrolling resident into hospice the following was revealed. Resident #1 had returned to the facility after an extended stay at the hospital due to an infection on 10/20/23***. The day after Resident #1 returned, the resident complained of severe stomach pains and was observed choking on what looked liked a nutritional supplement given to the resident by staff. Resident #1's resident representative was contacted by Arshalouis Manoukyan(aka Lucy), a friend of Marine Arshakyan, allegedly the new owner of the facility. Ms. Manoukyan was assisting at the facility while Ms. Arshakyan was out of the country. Resident #1's resident representative was told to come to the facility immediately as Resident #1 was not well and was dying. The resident representative was also told that Resident #1, would be given morphine and Resident #1 would pass away. As of this call, staff had not called 911. The resident representative told Lucy to call 911 and was told by her that the paramedics would not take Resident #1 in that condition and what was the point of taking Resident #1 to the hospital when resident was dying. The

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231107095933

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HM SWEET HOME	FACILITY NUMBER: 197609604
	VISIT DATE: 06/19/2024

NARRATIVE

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resident representative was not in the local area and immediately headed for the facility. Upon arrival about 25 minutes later, staff still had not contacted 911. Resident #1's mouth was observed with a bunch of white
liquid that looked like Ensure and the resident was choking and in distress. The resident representative observed that there was a nurse present in the facility and when she left, Lucy handed the resident representative some paperwork and was told by Lucy to sign them. The resident representative did not read the documents and was not given an explanation for the paperwork. The resident representative was in shock and had never been in this situation and did not question why documents needed to be signed. Per the resident representative, staff kept saying Resident #1 was dying and presumed that the paperwork was consent to allow Resident #1 to die. The resident representative also contacted another family member for guidance and the other family member spoke with staff and still 911 was not called. The resident representative could not understand why they were being told by Lucy that 911 personnel would not transport Resident #1 to the hospital in their condition. Resident representative finally called the telephone number they had for the unit where Resident #1 was hospitalized before the discharge and spoke with a nurse. Nurse advised the resident representative to call 911. Per information provided by resident representative, they went to call 911, when Lucy after getting off a phone call with, they believe was the hospice doctor, also called 911, almost 2 hours after the initial call to the resident representative.

Per the resident representative, they did not realize that the documents they signed were hospice documents until they received a text with a copy of a business card from the hospice agency after the incident. The resident representative believes that the documents were hospice documents based on the business card received via text. A copy of the signed documents were never provided to the resident representative when it was requested..

Per interview conducted with the hospice agency at 5:10pm on 6/18/24, they deny having any hospice care service agreement with Resident #1. Per the hospice agency, no one by Resident #1's name was ever billed for services.

Based on the information obtained from interviews, there is insufficient evidence to support the claim staff coerced resident representative to enroll Resident #1 into hospice. Although the allegation may have happened or is valid, there is insufficient evidence to prove that the resident representative was coerced by staff. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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