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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609749
Report Date: 07/18/2022
Date Signed: 08/15/2022 11:59:07 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/18/2022 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20220518141925
FACILITY NAME:ENCINO GARDENSFACILITY NUMBER:
197609749
ADMINISTRATOR:ARUTUNYAN, ALEXFACILITY TYPE:
740
ADDRESS:4930 NOELINE AVETELEPHONE:
(818) 983-5598
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:6CENSUS: 4DATE:
07/18/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Anahit GregoryanTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff verbally abused resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility. LPA met with Anahit Gregoryan and explained the reason for the visit. It was alleged that resident #1 (R1) is being verbally abused and yelled at by staff #1 (S1). To investigate this allegation, on 05/18/22, LPA reviewed evidence provided to Licensing from other sources from 2:30PM–3:00PM. On 05/23/22, LPA interviewed staff #2 and two out of four residents, R1 and resident #2, from 10:30AM–12:20PM. LPA was unable to interview resident #3 as they were asleep and resident #4 was not in good health. On 06/14/22, LPA made observations and interviewed S1 from 12:45PM-2:00PM. S1 denied verbally abusing/yelling at R1 or others. Residents denied being yelled at by facility staff. A review of the evidence obtained during the investigation revealed that S1 was yelling, threatening punishment, intimidating and humiliating a resident in care. Although interviews of residents and staff did not reveal any relevant information, based on the review of evidence from other sources, the allegation is substantiated at this time. Pursuant to Title 22 Div. 6 Ch. 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC9099-D): Exit interview was conducted, appeal rights were discussed, and a copy of report was issued.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
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 3
Control Number 31-AS-20220518141925
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ENCINO GARDENS
FACILITY NUMBER: 197609749
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2022
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature…
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The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87468.1 Personal Rights of Residents in All Facilities; The written letter must be sent to the LPA by the POC due date.
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This requirement is not met as evidenced by;
Based on evidence provided to licensing from other sources, the licensee did not ensure that the resident was free from punishment, humiliation, abuse and intimidation which poses an immediate health, safety and personal rights 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: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/18/2022 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20220518141925

FACILITY NAME:ENCINO GARDENSFACILITY NUMBER:
197609749
ADMINISTRATOR:ARUTUNYAN, ALEXFACILITY TYPE:
740
ADDRESS:4930 NOELINE AVETELEPHONE:
(818) 983-5598
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:6CENSUS: 4DATE:
07/18/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Anahit GregoryanTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility has more than one bedridden resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility. Upon entry, LPA met with ---- and explained the reason for the visit.

---Facility has more than one bedridden resident.

It was alleged that the facility has more than one bedridden resident. To investigate this allegation, on 06/14/2022, LPA made observations and interviewed staff from 12:45 PM - 2:00 PM. Interviews and observations revealed that there is only one bedridden resident at the facility and the remaining residents can reposition themselves and move about independently or with some assistance. Based on interviews and observations, there is not enough information to verify the allegation, therefore, the allegation is UNSUBSTANTIATED at this time.
No health and safety hazards were noted during the visit.
Exit interview was conducted and a copy of the report was issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
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 3