197609785-7-22-2022-31-AS-NMAN-CHVSMB-20220902135941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609785
Report Date: 07/21/2022
Date Signed: 07/22/2022 08:53:06 AM

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
11/29/2021 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20211129112308

FACILITY NAME:	EATON CANYON VILLAS I		FACILITY NUMBER:	197609785
ADMINISTRATOR:	GARIBYAN, ARMOND		FACILITY TYPE:	740
ADDRESS:	2518 GANESHA AVE		TELEPHONE:	(818) 429-0070
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	6	CENSUS: 6	DATE:	07/21/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Aura Amaya-Lopez, Manager		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff person takes resident's personal items.

Management allows staff with COVID symptoms to work with the residents.

Staff do not wash the resident's clothing.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced subsequent visit in order to deliver the findings for the above noted allegations. LPA met with Manager Aura Amaya-Lopez. The purpose of the visit was discussed.

It was reported that a staff person takes resident's personal items. To investigate this allegation, on 11/30/2021, LPA Valenzuela interviewed staff at 2:40pm. Interviews revealed that residents do not have any money at hand and that no resident has come forward and told management that any of their personal items are missing or have been stolen. On 7/21/2022 at 2:00pm, resident interviews were conducted. Interviews revealed that residents have all of their personal belongings and nothing is missing.

Based on interviews there is not sufficient information to support this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

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-20211129112308

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: EATON CANYON VILLAS I	FACILITY NUMBER: 197609785
	VISIT DATE: 07/21/2022

NARRATIVE

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It was alleged that management allows staff with Covid symptoms to work with the residents. To investigate this allegation on 11/30/2021 at 2:40pm, LPA interviewed staff. Interviews revealed that a staff member was coughing and sneezing. The licensee was notified and immediately asked the staff to get Covid tested. Staff was Covid tested and the results came back negative. In addition, on 7/21/2022 at 3:11pm, LPA checked the Field Automated System (FAS) and the facility has not reported to Licensing any Covid positive cases.

Based on interviews and record review, there is not sufficient information to support the allegation. Therefore, it has been deemed UNSUBSTANTIATED.

It was reported that staff do not wash the resident's clothing. To investigate this allegation, on 11/30/2021 at 2:40pm, LPA interviewed staff. Staff interviews revealed that clothing is washed daily. Bed linens are washed twice a week or as needed.

Based on interviews there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC9099 (FAS) - (06/04)

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