197609766-3-8-2022-31-AS-EMIR-CCTUJB-20220324153715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609766
Report Date: 03/08/2022
Date Signed: 03/08/2022 02:43:13 PM

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
03/01/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220301141750

FACILITY NAME:	HORIZON ASSISTED LIVING FACILITY		FACILITY NUMBER:	197609766
ADMINISTRATOR:	SONA GEVORKYAN		FACILITY TYPE:	740
ADDRESS:	9708 VALJEAN AVE		TELEPHONE:	(310) 720-4551
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 4	DATE:	03/08/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Sona Gevorkyan		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are mistreating a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to this facility to investigate the above allegation. The investigation consisted of a physical plant inspection, interviews and record review. Per interviews and record review, the investigation reveals each resident interviewed had no complaints or concerns regarding facility service. The residents that were interviewed stated they are never mistreated by staff. Residents stated that they are also treated with respect. When residents were asked if they've ever witnessed any of their peers being mistreated, they all stated no. Interviews with staff also do not corroborate with the allegation. Review of Resident 1's (R1) record indicates some confusion/disorientation that may need some orientation.

Based on the information obtained, there was insufficient evidence to confirm staff are mistreating a resident in care. Therefore, the allegation is deemed Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022

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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