197609766-7-30-2024-31-AS-NGID-D7YMVZ-20240809095730

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609766
Report Date: 07/30/2024
Date Signed: 07/30/2024 12:48:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
12/28/2022 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20221228133054

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: 5	DATE:	07/30/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Sona Gevorkyan, Administrator		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Facility is not allowing resident to move out of the facility
Facility staff did not have the ability to communicate with resident
Staff did not address a change in the resident's condition
Staff did not assist resident with transfers

INVESTIGATION FINDINGS:

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At 9:45 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced subsequent complaint visit. LPA met with the staff who granted access to the facility and shorly after Administrator Sona Gevorkyan arrived and LPA disclosed the reason for the visit.

A subsequent visit was conducted on 05/22/2024. During course of the investigation, interviews and record review were made. At 12:15 PM, LPA requested resident and staff roster. At 12:20 PM, LPAs requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, etc., relevant to the investigation. At approximately 12:35 PM, LPA conducted a physical plant tour. Between 12:45 PM to 2:00 PM, LPA conducted an interview with the Administrator, one staff, four (4) out of five (5) residents who were able to communicate, and a family member of a resident. Additional interviews and record reviews were also conducted during today’s visit.

Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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 3

Control Number 31-AS-20221228133054

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: HORIZON ASSISTED LIVING FACILITY	FACILITY NUMBER: 197609766
	VISIT DATE: 07/30/2024

NARRATIVE

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Facility is not allowing resident to move out of the facility:
It is alleged that the facility did not allow R1 to move out of the facility. To investigate this allegation LPA conducted interviews with the Administrator, one (1) staff, and four (4) out of five (5) residents who were able to communicate. Interview with the Administrator revealed that R1 did not have any family member or POA. R1 was admitted to the facility via referring agency. A random person that the facility had no record of came to the facility to take R1. The Administrator did not allow since there were no evidence of any kind of relation to R1. Additionally, Interview with four (4) out of five (5) residents did not have any issues moving out of the facility at any time they wanted. Based on interviews this allegation is Unsubstantiated at this time.

Facility staff did not have the ability to communicate with resident:
It is alleged that the facility staff are not able to communicate with R1 in Spanish. To investigate this allegation LPA conducted interview with the Administrator and one (1) staff. It was revealed that although the staff did not understand Spanish nor could speak it, yet they were able to understand R1 by using google translation application via their phones. Moreover, four (4) out of five (5) residents interviewed, revealed they can effectively communicate their needs with the facility staff without any issues. During the visit, LPA observed that all staff understand and can communicate with basic English to the majority of the residents who are communicating in English without any problem. Based on interviews and LPA’s observation this allegation is Unsubstantiated at this time.

Staff did not address a change in the resident's condition:
It is alleged that R1 lost weight due to lack of care. To investigate the above allegation LPA conducted an interview with the Administrator and as informed that when R1 was admitted to this facility, R1 was already receiving Hospice services due to his/her medical condition. Moreover, review of hospice file indicated that R1 was on a mechanical soft diet and was able to tolerate thin liquid with total of 25% oral meal intakes, and due to slow and steady decline R1 was hospice appropriate; However, it was determined/ordered by hospice doctor to discharge R1 from hospice on 12/28/2022 and admit R1 to the hospital for further evaluation. On 1/1/2023 R1 returned to the facility and was admitted back to receiving hospice services. During today’s visit, LPA was provided with the hospice doctor’s order dated on 12/28/2022. Based on interviews and record reviews this allegation is deemed Unsubstantiated at this time.

Continue on LIC 9099C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20221228133054

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: HORIZON ASSISTED LIVING FACILITY	FACILITY NUMBER: 197609766
	VISIT DATE: 07/30/2024

NARRATIVE

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Staff did not assist resident with transfers:
It is alleged that R1 cannot go outside because there are no staff to take R1 outside. To investigate this allegation LPA conducted interviews with the Administrator and one (1) staff and all parties dined the above allegation. Moreover, interviews with four (4) out of five (5) residents did not have any concerns regarding the above allegation. During the time of both visits on 05/22/2024 and as well on 07/30/2024, LPA observed that the staff are helping residents with transfers and other assistance they need. Based on interviews and LPA’s observation this allegation is deemed Unsubstantiated as this time.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

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