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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609789
Report Date: 01/16/2024
Date Signed: 01/16/2024 05:17:01 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
11/07/2023 and conducted by Evaluator Christopher Alemoh
COMPLAINT CONTROL NUMBER: 31-AS-20231107111203
FACILITY NAME:LAURELGROVE MANOR 2FACILITY NUMBER:
197609789
ADMINISTRATOR:AVETIS VARDANYANFACILITY TYPE:
735
ADDRESS:13557 RANGOON STTELEPHONE:
(747) 272-3093
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY:4CENSUS: 3DATE:
01/16/2024
UNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Avetis VardanyanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident not accorded dignity in his/her personal relationships with staff and other persons..

Staff did not keep resident's personal information confidential
INVESTIGATION FINDINGS:
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On 01/16/2024 at 09:24AM Licensing Program Analyst (LPA) Christopher Alemoh conducted a complaint visit to the facility to investigate the above allegations. LPA met with the Administrator, Alvard Yervandyan, and advised them of the complaint.

It was alleged that staff did not keep residents’ personal information confidential. To investigate the allegation, on 01/16/2023 at 09:50AM LPA conducted a physical plant tour to ensure facility is in compliance with Title 22. At 11:15AM LPA requested resident files and interviewed two (2) residents. At 0135 LPA interviewed three (3) staff and one (1) resident. Interviews with the administrator and staff do not corroborate with the allegation. According to the administrator and staff. Resident information is personal and never shared under any circumstances. All staff stated residents can safely and privately speak with staff in their rooms or the backyard. All residents stated they have never witnessed or heard any staff or residents speaking negatively about another person.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
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 2
Control Number 31-AS-20231107111203
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: LAURELGROVE MANOR 2
FACILITY NUMBER: 197609789
VISIT DATE: 01/16/2024
NARRATIVE
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At the time of the visit LPA observed residents and staff interacting with no issue. All confidential resident information is locked and stored in a filing cabinet. During a file review LPA observed confidential and or privacy documents are signed and dated.

In regard to the second allegation resident not accorded dignity in his personal relationships with staff and others. All Staff interviewed denied the allegation. They stated that they have not observed any staff mistreat any residents. S1 interview revealed they did not like to speak in front of others. S1 stated all meetings were conducted at his parents house to remedy this. All other interviews show that facility staff treat residents with dignity and respect. All residents have private conversations with staff either in the backyard or in there room. Residents interviewed were unable to corroborate the allegation.. Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No health and safety hazards noted during the visit.

Exit interview was conducted with Alvard Yervandyan and a copy of the report was issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2