197609604-2-28-2025-29-AS-KHEN-DEC8MT-20250228213852

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609604
Report Date: 02/28/2025
Date Signed: 02/28/2025 05:13:56 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
12/09/2024 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20241209121256

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:	02/28/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Elena Kordonskiy, Administrator		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

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1. Staff does not give resident medication.
2. Staff does not allow resident to make phone calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA), Christine Yee conducted a subsequent unannounced complaint visit to continue the investigation for the above allegations. LPA Yee was let into the home by Emilya Hovsepyan, Staff. Staff contacted Elena Kordonskiy, Administrator and she arrived at 1:44pm to conduct the visit.
The reason for today's visit was provided.

On 12/11/24, Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced initial 10-day complaint visit to investigate the above allegations. On today's visit at 9:45 a.m., LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. LPA met with Administrator Elena Kordonskiy and explained the reason for the visit. Entrance interview conducted. On 12/09/2024, the Department received a complaint regarding the following allegations, Staff does not give resident medication and Staff does not allow resident to make phone calls. LPA toured the physical plant areas inside and outside to

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

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-20241209121256

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: 02/28/2025

NARRATIVE

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ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations.

On the 12/11/24 visit, LPA Mosley conducted a physical plant tour at 9:45 a.m. to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations. Interviewed three (3) out of five (5) residents from 10:55 A.M. – 12:00 P.M., interviewed two (2) staff including the Administrator from 12:30 P.M. – 2:00 P.M., Reviewed and collected relevant documents pertaining to the investigation and conducted a medication audit on the current residents.
Based on the information received and due to time constraints, further investigation is needed to make a finding for the above allegations. An exit interview was conducted.

On today's visit, training files, resident files were requested for review and was not provided by the Administrator. No interviews were also conducted as Resident #1 is not known to the current residents in care.

Regarding allegation #1 Staff does not give resident medication, Facility records were previously requested for Resident #1 on previous facility visits and was requested again today, from staff and from the current Administrator and the file could not be produced each time. Per interviews conducted by LPA Mosley on 12/11/24 she was informed that Resident #1 lived at the facility for 1 day as the reason for why there were no documents for the resident. However, per review of Department records for a visit that was conducted on 2/29/24, Resident #1 was admitted on 6/9/23, therefore there is no reason for the facility not to have a facility file for the resident. Attempts were made to interview Resident #1 during the initial complaint visit but the resident was not on site. Resident #1 also could not be interviewed on any subsequent visits to the facility as the resident no longer lived at the home and the relocation site is unknown. Based on the facility’s failure to maintain complete records for the residents and the unknown location of Resident #1, LPA Yee could not conclusively determine if the facility Staff does not give resident medication and has determined the finding to be unsubstantiated at this time. A new complaint will be written up once more information can be obtained.

continued on LIC9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20241209121256

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: 02/28/2025

NARRATIVE

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Allegation #2 - Staff does not allow resident to make phone calls.

Per interviews conducted with the residents in care by LPA Mosley on 12/11/24 and by LPA Yee on 2/27/25 related to another complaint with the same allegation, the residents all indicated that they have not had problems using the facility phone located in the kitchen. The facility staff do not refuse them or prevent them from making calls on the facility line. Some of the residents interviewed also have their personal cell phones but still choose to make calls on the facility line. Per Staff interviews conducted with Staff #1 and Staff #2, they do not refuse the residents’ the use of the facility phone. Based on the interviews conducted, there is insufficient evidence to support the allegation that staff does not allow resident to make phone calls at this time, therefore the allegation is unsubstantiated at this time.

No deficiencies were cited on today's visit.

Exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025

LIC9099 (FAS) - (06/04)

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