197609793-7-2-2021-29-AS-DPEA-CNM5DB-20230131185136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609793
Report Date: 07/02/2021
Date Signed: 07/02/2021 02:45:07 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
09/16/2020 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20200916160807

FACILITY NAME:	SAINT CLAIR ASSISTED LIVING		FACILITY NUMBER:	197609793
ADMINISTRATOR:	ANI MKRTCHYAN		FACILITY TYPE:	740
ADDRESS:	6608 SAINT CLAIR AVE		TELEPHONE:	(323) 793-8228
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 6	DATE:	07/02/2021
		UNANNOUNCED	TIME BEGAN:	01:29 PM
MET WITH:	Emma Arutiunian		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) Brian Balisi and Salia Walker conducted an unannounced subsequent investigation for the allegation listed above. Upon arrival LPAs met with Emma Arutiunian and explained the reason for the visit.
During the course of the investigation, LPAs conducted a physical plant tour virtually on 02/26/2021 as well as interviewed Administrator. Between 1:00pm – 3:00pm, LPAs conducted physical plant, 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 and 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: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
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