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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609604
Report Date: 02/27/2024
Date Signed: 02/27/2024 03:06:28 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 HOMEFACILITY NUMBER:
197609604
ADMINISTRATOR:NADRIAN, ASMIKFACILITY TYPE:
740
ADDRESS:6215 BLUEBELL AVENUETELEPHONE:
(818) 903-6302
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 3DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Asmik Nadrian, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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1. Staff forced resident to drink nutritional supplement while in care causing hospitalization.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Yee met with Asmik Nadrian, Administrator and explained the reason for the visit.

On 11/07/2023, the Department received a complaint regarding an allegation of Neglect/Lack of Care and Supervision. It was alleged that Resident #1 (R1) was forced to drink a nutritional drink, causing hospitalization. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Olivia Spindola.

On 11/08/2023, from 10:14am to 4:15pm, Licensing Program Analyst (LPA) Christine Yee conducted an unannounced initial complaint visit in conjunction with a health and safety visit and was let into the home
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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 7
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: 02/27/2024
NARRATIVE
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by staff. Asmik Nadrian, Administrator/Licensee was contacted by staff and was not reachable via phone and did not participate in the visit. The facility also did not have evidence of a designated responsible staff when the Administrator is not present at the facility. During the visit LPA Yee toured the facility at 1:15pm, no immediate safety concerns were observed for the physical plant. The LPA reviewed the food supply at 1:30pm, observed 4 residents in care at 1:40pm, and reviewed 6 resident files at 10:30am. Copies of files for Resident #1 (R1) and Resident #6 (R6) were obtained. No interviews were conducted as staff present had no information or spoke very limited English. Marine Arshakyan, administrator arrived around 1:20pm. Per Marine, she became co-administrator about 6 years ago. The LPA determined further investigation was required prior to issuing findings.

Investigator Spindola conducted interviews on 11/29/2023, from approximately 12:00pm to 1:00pm, with the administrator, staff, and co-administrator; on 12/28/2023, from approximately 8:20am to 9:40am, with the administrator, residents, and staff; on 01/10/2024, at approximately 11:00am, with R1’s resident representative; on 01/18/2024, at approximately 11:30am, with R1; and on 01/30/2024, at approximately 9:30am, with the administrator. In addition, the investigator reviewed Providence Saint Joseph’s Hospital (PSJH) medical records and facility file documents related to R1.

According to R1’s physician’s report, dated 07/08/2022, R1’s diagnosis included hypertension, heart disease, diabetes type 2, and major depression. The report listed mild cognitive impairment (MCI) and a special diet due to diabetes and hypertension.

The investigation revealed that on 10/07/2023, R1 was hospitalized at Providence Saint Joseph’s Hospital (PSJH). The PSJH records indicated that R1 was diagnosed with “…pneumonia of both lungs due to infectious organism, unspecified part of lung...epigastric pain, gallbladder necrosis, sepsis, metabolic encephalopathy, cholecystitis …Successful ultrasound guided percutaneous cholecystostomy…Status post cholecystostomy tube placement…Continue antibiotics…”. R1 was released to the facility on 10/20/2023. Staff interviews revealed that upon R1’s discharge back to the facility on 10/20/2023, R1 could not eat solid food and was given Ensure protein drinks. Per R1, when
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7
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: 02/27/2024
NARRATIVE
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they returned from the hospital, they were throwing up and could not eat and staff gave R1 Ensure. Information obtained through interviews with staff and R1 did not indicate R1 was forced to drink Ensure.

On 10/21/2023, R1 suffered severe stomach pain and was again hospitalized at PSJH in critical condition. The medical records documented “…ER…acute altered mental status and respiratory failure with hypoxia. Patient is fairly obtunded and comatose…bacteremia and intra-abdominal infection …Physical therapy recommended upon discharge…to solve for: impaired functional mobility secondary to impaired functional endurance/tolerance…”.

Based on the medical records and interviews conducted, the Department concluded that there was insufficient evidence to substantiate the allegation. Therefore, the allegation “Physical Abuse: Facility staff forced resident to drink nutritional supplement, causing hospitalization” is deemed Unsubstantiated at this time.

Exit interview conducted, copy of this report issued.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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 HOMEFACILITY NUMBER:
197609604
ADMINISTRATOR:NADRIAN, ASMIKFACILITY TYPE:
740
ADDRESS:6215 BLUEBELL AVENUETELEPHONE:
(818) 903-6302
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 3DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Asmik Nadrian, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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3. Staff did not seek medical attention for resident in care in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA Yee met with Asmik Nadrian and explained the reason for the visit.

On 11/07/2023, the Department received a complaint regarding an allegation of Neglect/Lack of Care and Supervision. It was alleged that staff did not seek timely medical attention for Resident #1 (R1) when R1 complained of severe stomach pain on 10/21/2023. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Olivia Spindola.

On 11/08/2023, from 10:14am to 4:15pm, Licensing Program Analyst (LPA) Christine Yee conducted an unannounced initial complaint visit in conjunction with a health and safety visit and was let into the home by
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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 7
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: 02/27/2024
NARRATIVE
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staff. Asmik Nadrian, Administrator/Licensee was contacted by staff and was not reachable via phone and did not participate in the visit. The facility also did not have evidence of a designated responsible staff when the Administrator is not present at the facility. During the visit LPA Yee toured the facility at 1:15pm, no immediate safety concerns were observed for the physical plant. The LPA reviewed the food supply at 1:30pm, observed 4 residents in care at 1:40pm, and reviewed 6 resident files at 10:30am. Copies of files for Resident #1 (R1) and Resident #6 (R6) were obtained. No interviews were conducted as staff present had no information or spoke very limited English. Marine Arshakyan, administrator arrived around 1:20pm. Per Marine, she became co-administrator about 6 years ago. The LPA determined further investigation was required prior to issuing findings.

Investigator Spindola conducted interviews on 11/29/2023, from approximately 12:00pm to 1:00pm, with the administrator, staff, and co-administrator; on 12/28/2023, from approximately 8:20am to 9:40am, with the administrator, residents, and staff; on 01/10/2024, at approximately 11:00am, with R1’s resident representative; on 01/18/2024, at approximately 11:30am, with R1; and on 01/30/2024, at approximately 9:30am, with the administrator. In addition, the investigator reviewed Providence Saint Joseph’s Hospital (PSJH) medical records and facility file documents related to R1.

According to R1’s physician’s report, dated 07/08/2022, R1’s diagnosis included hypertension, heart disease, diabetes type 2, and major depression. The report listed mild cognitive impairment (MCI) and a special diet due to diabetes and hypertension.

According to the PSJH medical records, R1 was hospitalized from 10/07/2023 to 10/20/2023. The hospital records indicate that R1 was diagnosed with pneumonia of both lungs due to infectious organism, unspecified part of lung, epigastric pain, gallbladder necrosis, sepsis, metabolic encephalopathy, and cholecystitis. While in the hospital, a cholecystostomy tube placement was performed. R1 was given antibiotics and discharged to the facility on 10/20/2023.

The investigation revealed that on 10/21/2023, Staff #1 (S1) called the facility administrator, Asmik
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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: 02/27/2024
NARRATIVE
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Nadrian, and told her R1 was very ill. R1 was screaming in pain and complained of severe stomach pain. The administrator called R1’s resident representative and informed them that R1 was “dying” and needed hospice care. R1’s resident representative told the administrator to call 911. When R1’s resident representative arrived at the facility approximately one hour later, S1 and Staff #2 (S2) had not called 911. R1 appeared to be struggling to breathe, R1’s tongue was sticking out of their mouth, and they were semiconscious. When R1’s resident representative asked S1, S2, and Staff #3 (S3) why they had not called 911 to get emergency care for R1 they told R1’s resident representative 911 would not send an ambulance because R1 was dying. S3 had R1’s resident representative sign hospice documents who told them R1 needed Morphine so they could die in peace. R1’s resident representative asked the staff when hospice was going to administer the Morphine, since they could see R1 struggling to breathe. They told R1’s resident representative in approximately one hour. R1’s resident representative decided to contact PSJH to get medical advice. PSJH told R1’s resident representative to send R1 to the hospital. R1’s resident representative called 911, and R1 was admitted to the hospital with acute altered mental status and respiratory failure with hypoxia. The medical records documented “Patient is fairly obtunded and comatose…vancomycin starting on 10/22/2023 for bacteremia and intra-abdominal infection…Physical therapy recommended discharge…to solve for: impaired functional mobility secondary to impaired functional endurance/tolerance…” On 10/29/2023, R1 was discharged to Burbank Health Care and Rehabilitation Center.

Based on the medical records and interviews conducted, the Department concluded that there was sufficient information to substantiate the allegation. Therefore, the allegation “Neglect/Lack of Care and Supervision: Facility staff did not seek medical attention for resident in a timely manner” is deemed Substantiated at this time A $500 immediate civil penalty is assessed today. The Licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(f).

Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D)
Exit interview conducted, civil penalty issued, appeal rights discussed, and a copy of this report issued.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2024
Section Cited
CCR
87465(a)(1)
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Incidental Medical and Dental Care:(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care by compliance with the following: (1) The licensee shall arrange, or assist in
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The licensee will submit a plan on how you will ensure you will provide timely medical attention for residents in care. Submit to CCL by 2/28/24
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 arranging, for medical and dental care appropriate to the conditions and needs of residents.This requirement is not met as evidenced by: Facility staff failed to seek immediate medical attention when R1 suffered severe stomach pain requiring hospitalization, which posed an immediate 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: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7