197609604-2-27-2025-29-AS-KHEN-DEC4C9-20250228175847

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609604
Report Date: 02/27/2025
Date Signed: 02/27/2025 06:53:26 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
02/23/2024 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240223115007

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:	02/27/2025
		UNANNOUNCED	TIME BEGAN:	12:13 PM
MET WITH:	Mariam Boghdoyan, Staff		TIME COMPLETED:	07:05 PM

ALLEGATION(S):

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1. Staff hit resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced subsequent complaint visit and was let into the home by Mariam Baghdoyan, Staff. Elena Kordonskiy, Administrator was contacted by Mariam Baghdoyan, Staff and LPA Yee via telephone and she was unreachable. LPA Yee also contacted Asmik Nadrian, Licensee and she was also unreacheable. The reason for today's visit was explained to staff.
Resident files were requested and again, records could not be provided. Per Mariam, she is just an employee. The reason for today's visit was provided. At 1:17pm a text was received from the Administrator advising LPA Yee that she was at the facility this morning and is currently out of town.

On 2/29/24, Licensing Program Analyst (LPA) conducted an initial unannounced complaint visit and was let into the home by Mariam Baghdoyan, Staff. Staff contacted Marine Arshakyan who was unavailable for medical reasons and Askmik Nadrian was working her full time job and was also unavailable. LPA Yee explained the reason for the visit to Mariam Baghdoyan. During the initial visit conducted on 2/29/24, LPA Yee reviewed 6 residents files beginning at 11:01am, conducted telephone interview with the Reporting

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

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-20240223115007

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: 02/27/2025

NARRATIVE

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Party(RP) at 1:59pm, Resident #1 at 2:54pm and Staff #1 at 4:15pm. Based on information received on the initial visit, further investigation is needed to make a finding for the above allegations. Exit interview was conducted.

Per interview conducted with Staff #1 regarding Allegation #1 – Staff hit resident, during the initial visit, the police were at the facility on 2/23/24 around 7pm. Per Staff #1, who does not speak much English, they called Marine Arshakyan, Staff. The police spoke with Marine and Resident #1. Resident #1 denied calling the police and they apologized and left the home. Per information received from interviews conducted with Resident #1, either Staff #1 or Staff #2 grabbed them roughly but was not sure if they hit them. Resident #1 also said later in the interview, that staff hit them on their shoulder and arm. The staff who did the hitting was not specifically identified by the resident. LPA was being given conflicting information, Resident #1 was specifically asked if they were hit by staff and resident did not respond. Per Resident #1, they are constantly afraid of staff. Staff #1 is “good” and Staff #2 is nasty. Per Resident #1, Staff are physically and verbally abusive and they are afraid of retaliation. Per interviews conducted today with Staff #1 at 1:01pm and Staff #2 at 1:04pm, they both deny ever hitting, yelling or grabbing residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the violation did or did not occur, therefore the allegation that staff hit resident is deemed unsubstantiated at this time.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
02/23/2024 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20240223115007

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:	02/27/2025
		UNANNOUNCED	TIME BEGAN:	12:13 PM
MET WITH:	Mariam Boghdoyan, Staff		TIME COMPLETED:	07:05 PM

ALLEGATION(S):

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9

2. Staff do not assist resident with obtaining medication
3. Staff do not assist resident with obtaining medical care

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20240223115007

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: 02/27/2025

NARRATIVE

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Yee reviewed 6 residents files beginning at 11:01am, conducted telephone interview with the Reporting
Party(RP) at 1:59pm, Resident #1 at 2:54pm and Staff #1 at 4:15pm. Based on information received on the initial visit, further investigation is needed to make a finding for the above allegations. Exit interview was conducted.

During the initial complaint visit conducted on 2/29/24, the following information was received for the allegations that Staff do not assist resident with obtaining medication and Staff do not assist residents with obtaining medical care. Per interview conducted with Resident #1, resident used to take Trazadone 150mg at night before they came to this facility. It helps relax them. Resident #1 also indicated that they also used to take Miralax powder with water for their stomach before they went to the hospital. Now the doctor has prescribed them Ducosate. Ducosate does not work, only Miralax does. Per review of the Centrally Stored Medication and Destruction Record, Resident #1 was admitted to the home on 1/23/24 and they did did not get their medications filled until February 2/21/2024 and 2/24/24. Since the facility does not maintain resident records or have any paperwork for review, it is unknown as to why the resident did not get their medications filled timely and when they were admitted to the home. Staff present on today's visit advised LPA Yee that medication issues are handled by the Administrator. They just notify the Administrator if there are any medication issues or medical appointments needed. They are just employees. It has been observed by LPA on many visits to the facility that the Licensee, who was also the former Administrator holds a full time job and current administrator only works part time in the evening and are not present at the facility in insufficient number of hours to administer the facility. Based on the information obtained during the investigation, there is sufficient evidence to support the allegations that Staff do not assist residents with obtaining their medication and Staff do not assist residents with obtaining medical care, therefore the allegation is substantiated at this time.

Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8

Exit interview was conducted, APPEALS RIGHTS discussed and copy was given.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20240223115007

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/27/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/06/2025 Section Cited CCR 87464(d)	1 2 3 4 5 6 7	Basic Services: A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457	1 2 3 4 5 6 7	Licensee will provide the Department with a written action plan that will be implemented to ensure that all residents are provided services needed and identified in their care plan, including medications and medical appointments that are needed for maintaining their health and wellbeing by 3/6/25
	8 9 10 11 12 13 14	Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. This requirement was not met as evidenced by: Resident #1 was admitted to the facility on 1/23/24 and did not get their medications until 2/21/24 and 2/24/24.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 5