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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609604
Report Date: 12/27/2023
Date Signed: 12/28/2023 08:16:18 AM

Substantiated


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
12/22/2023 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20231222121315
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:
12/27/2023
UNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Marine ArshakyanTIME COMPLETED:
11:47 AM
ALLEGATION(S):
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Staff do not ensure grab bars are present in resident's bathroom
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted an initial complaint visit to the facility. Upon arrival there were two caregivers present. Caregiver 1 (C1) called the administrator to come to the facility. Administrator Marine Arshakyan arrived at 10:32 a.m. LPA explained the reason for the visit.

At 9:45 a.m. LPA conducted a brief tour of the facility. There are three bathrooms at the facility. The only bathroom with handrails next to the toilet and in the shower is the hall bathroom. Bedroom one (1) and Bedroom three (3) both have private bathrooms. The bathroom in Bedroom three has a handrail across from the toilet but none in the shower. The bathroom in Bedroom one has no handrails.

Based on LPA's observations, the allegation staff do not ensure grab bars are present in the resident's bathroom is deemed Substantiated at this time. Per California Code of Regulations (CCR), Title 22, see LIC 9099-D for deficiencies cited. Exit interview conducted. A copy of the report was issued, along with appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
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-20231222121315
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: 12/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2024
Section Cited
CCR
87303(e)(4)
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87303 Maintenance and Operation. (e) Water supplies and plumbing fixtures shall be maintained as follows: (4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents. This regulation was not met as evidenced by:
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Licensee will install grab bars in the showers and next to the toilets of the private restrooms in bedrooms one (1) and three (3) and send evidence of this to CCL on or before 1/5/2024.
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Based on LPA's observations, the licensee did not comply with the section cited above, as two out of three bathrooms were observed to not have grab bars, which poses a potential health and safety 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: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3