197609771-6-14-2023-29-AS-DPEA-CT7PP3-20230627112851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609771
Report Date: 06/14/2023
Date Signed: 06/14/2023 03:21:13 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/12/2023 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20230112141142

FACILITY NAME:	ETERNAL LIFE SENIOR CARE FACILITY		FACILITY NUMBER:	197609771
ADMINISTRATOR:	AVETIKYAN, OLGA		FACILITY TYPE:	740
ADDRESS:	8112 CROSNOE AVENUE		TELEPHONE:	(818) 988-7878
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91402
CAPACITY:	6	CENSUS: 4	DATE:	06/14/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Olga Avetikyan, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee did not provide 60 days notice of eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced subsequent complaint visit at the facility today to deliver findings. At 9:25 a.m., the LPA met with facility staff and explained the reason for the visit. At 9:44 a.m., the Administrator, Olga Avetikyan arrived at the facility.

During the initial visit on 01/12/2023, between 1:28 p.m. and 1:50 p.m., LPA Peraldi conducted a brief physical plant tour, interviewed the Administrator, and requested pertinent documents. On 01/12/2023, between 1:51 p.m. and 3:28 p.m., the LPA conducted one (1) staff interview, one (1) resident interview and two (2) resident family member’s interviews. Additionally, on 01/12/2023, at 3:22 p.m., the LPA attempted to interview three (3) residents. During today’s visit, between 9:45 a.m. and 10:15 a.m., the LPA conducted an interview with the Administrator and conducted a physical plant tour. At 10:22 a.m., the LPA also attempted to interview four (4) residents. Additionally, on 06/14/2023, the LPA reviewed pertinent documents such as resident’s admission agreements. Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

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 29-AS-20230112141142

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ETERNAL LIFE SENIOR CARE FACILITY	FACILITY NUMBER: 197609771
	VISIT DATE: 06/14/2023

NARRATIVE

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Regarding the allegation: Licensee did not provide 60 days’ notice of eviction. On 01/12/2023, the Department received a complaint alleging that Resident #1 (R1) was told by the Administrator that staff had quit, and that the facility was going to close in two (2) weeks. Interview with R1 on 01/12/2023, revealed that the Administrator told R1 that the facility will be closing since facility staff were quitting. The interview conducted with the Administrator on 01/12/2023, revealed that the Administrator did tell R1 that if facility staff quit, then she would be left with no choice but to close the facility. The Administrator stated that she never meant that the facility was going to close immediately and thus why she never served R1 with a proper notice of eviction. The Administrator stated that if the facility were to close, then she will provide a proper 60-day eviction notice. Interview conducted on 06/14/2023 with the Administrator revealed that the Administrator does not remember telling R1 that the facility could close soon, but she does remember telling R1’s family member that the facility could be potentially closing. The LPA reminded the Administrator that verbal eviction notices are not valid. Although, the Administrator told R1 that the facility might potentially close; the facility is not closing therefore there was no need for a 60-day notice of eviction. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 593-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

LIC9099 (FAS) - (06/04)

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