197609793-7-2-2021-29-AS-JAPL-C5AVAL-20210726161602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609793
Report Date: 07/02/2021
Date Signed: 07/02/2021 03:00:55 PM

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
06/28/2021 and conducted by Evaluator Salia Walker

COMPLAINT CONTROL NUMBER: 29-AS-20210628095819

FACILITY NAME:	SAINT CLAIR ASSISTED LIVING		FACILITY NUMBER:	197609793
ADMINISTRATOR:	ARMENUHI AVETIYAN		FACILITY TYPE:	740
ADDRESS:	6608 SAINT CLAIR AVE		TELEPHONE:	(818) 983-2224
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 6	DATE:	07/02/2021
		UNANNOUNCED	TIME BEGAN:	12:11 PM
MET WITH:	Emma Arutiunian, Staff		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are blocking doors and hallways

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Salia Walker and Brian Balisi conducted an unannounced investigation for the allegation listed above. Upon arrival LPAs met with Emma Arutiunian and explained the reason for the visit. Between 12:11pm – 3:00pm, LPAs conducted physical plant tour, interviewed residents and staff as well as reviewed and obtained copies of pertinent documents relevant to the investigation.

In regards to the allegation that Staff are blocking doors and hallways, during physical plant LPAs did not observe any doors or hallways blocked at this time. LPAs' interviews with residents and their family members revealed that most of them have never observed doors or hallways ever blocked. Based on information gathered during this and previous visit the department does not have sufficient evidence to confirm that staff are blocking doors and hallways at this time. Therefore, this allegation has been UNSUBSTANTIATED at this time.

Exit interview conducted, copy of report issued and sent via email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

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