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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609604
Report Date: 10/12/2023
Date Signed: 10/12/2023 04:58:59 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
10/10/2023 and conducted by Evaluator Christine Yee
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20231010161119
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: 6DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Amelia Hovespian, StaffTIME COMPLETED:
05:10 PM
ALLEGATION(S):
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1. Staff did not seek medical attention for resident in care in a timely manner
2. Licensee does not ensure that facility is adequately staffed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and was let into the home by Amelia "Narra" Hovsepian, Staff. Asmik Nadrian, Administrator, was contacted by staff and advised that LPA Yee was onsite. The Administrator participated in today's visit via telephone. The reason for today's visit was explained.

On today's visit, LPA Yee conducted an interview with Resident #2 at 11:01am, Resident #3 at 12:26pm, Staff #1 at 11:42am and the Administrator at 12:01pm via telephone.

Per information obtained from the interviews regarding Allegation #1- Staff did not seek medical attention for resident in care in a timely manner, on the moning of Tuesday 10/10/23, Resident #1 was complaining of stomach pain. Resident #1 has a history of complaining of stomach pains . Per the Administrator and Staff
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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 2
Control Number 29-AS-20231010161119
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: 10/12/2023
NARRATIVE
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#1, Resident #1 informed them that she/he has ulcers. Per Staff #1, she offered to call 911 and Resident #1 kept refusing. The pain got severe as the morning progressed and Staff #1 was finally able to convince resident to go to the hospital to be assessed. The call to 911 was made by Resident #2, who stated that she did it because Staff #1 did not not speak English. Per Resident #2, Resident#1 was coughing and hecklng and had a hard time breathing. Resident #2 stated that Staff #1 was present. Per interview with Resident #3, she/he did not observe the Paramedics at the facility on 10/10/23. However, there are always two ladies working at the facility except one lady is currently on vacation. Resident #3 stated that she/he has not being been left alone. Per interview with the Administrator, she spoke with the paramedics and Staff #1 gave the paramedics Resident #1's records. The primary care doctor's name and a list of medications were obtained from the file. Based on the information provided, there is insufficient evidence to establish that the facility staff did not provide timely medical care as residents may refuse medical care.

In regards to allegation #2 Licensee does not ensure that facility is adequately staffed, the facility has a total of 4 staff. Per review of the facility schedule, two staff are scheduled to work from 8am - 8pm and 2 staff work from 8pm - 8am normally. In the last few days, due to medical reasons, two night shift staff are temporarily unable to work their shift. Per the Administrator, she has temporarily reassigned one of the day shift staff to work the night shift to ensure staff coverage at night. Two of residents are able to self care, three residents are in bed most of the time and one is away in the hospital. Per observation on today's visit, it appears that the temporary one staff per shift schedule is able to meet the needs of the residents currently in care. Residents have been fed, changed and dressed. Per interview with the Administrator, she is in the process of finding extra help to assist the two staff. LPA Yee was not able to conclusively determine that the facility is not adequately staffed.

Per information received from interviews and file review, the above allegations are unsubstantiated.

Exit interview was conducted with Amelia "Narra" Hovsepian and a copy of this report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2