197609766-6-8-2022-31-AS-NMAN-CFFVW9-20220616164733

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609766
Report Date: 06/08/2022
Date Signed: 06/08/2022 01:38:19 PM

Unsubstantiated

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
05/21/2020 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20200521115717

FACILITY NAME:	HORIZON ASSISTED LIVING FACILITY		FACILITY NUMBER:	197609766
ADMINISTRATOR:	SONA GEVORKYAN		FACILITY TYPE:	740
ADDRESS:	9708 VALJEAN AVE		TELEPHONE:	(818) 300-8393
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 4	DATE:	06/08/2022
		UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	Sona Gevorkyan		TIME COMPLETED:	01:23 PM

ALLEGATION(S):

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Resident's needs are not being met.
Staff speak inappropriately to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility. Upon entry, LPA met with the administrator, Sona Gevorkyan, and explained the reason for the visit.

--- Resident’s needs are not being met.

It was alleged that the resident is deteriorating fast. To investigate this allegation, on 06/01/2020, LPA Martina Berry interviewed staff, responsible party and complainant. On 06/08/2022, LPA Abeye Duguma interviewed residents and requested the resident’s file. Interviews and record review revealed that staff are meeting the needs of Resident #1 (R1), that R1 suffered from a stroke and was diagnosed with dementia which can alter behavior as the resident’s health deteriorates. Based on interviews and record review, the allegation is unsubstantiated at this time.
(cont. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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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Control Number 31-AS-20200521115717

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: HORIZON ASSISTED LIVING FACILITY	FACILITY NUMBER: 197609766
	VISIT DATE: 06/08/2022

NARRATIVE

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--- Staff speak inappropriately to resident.

It was alleged that staff are verbally abusive. To investigate this allegation, on 06/01/2020, LPA Martina Berry interviewed staff, responsible party and complainant. On 06/08/2022, LPA Abeye Duguma interviewed residents. Interviews revealed that staff are treating residents well, staff are not treating residents inappropriately and that staff are not verbally abusive towards residents. Based on interviews, the allegation is unsubstantiated at this time.

No other deficiencies were noted during the visit. Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC9099 (FAS) - (06/04)

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