197609793-8-17-2021-29-AS-DPEA-C85UJK-20211025153736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609793
Report Date: 08/17/2021
Date Signed: 08/17/2021 02:51:30 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
02/16/2021 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20210216101813

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: 5	DATE:	08/17/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ani Gabrielian - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff has not provided access to former resident's belongings

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent visit for the above allegation. LPA met with Ani Gabrielian and explained the reason for the visit.
During the investigation, LPA conducted a physical plant tour virtually on 02/16/2021 as well as interviewed Administrator. Today LPA conducted interviews with facility staff, residents and other relevant parties. LPA also gathered and reviewed facility documentation pertinent to the allegation.
It was alleged that staff has not provided access to former resident's belongings. LPA interview with former Administrator revealed they never admitted Resident 1 (R1). LPA records review of roster revealed R1 never resided at this location. LPAs interview with other relevant parties with knowledge of R1 revealed that the address that R1 has listed as previous addess does not match this facility. Based on information gathered during this and previous visits, the department does not have any sufficient evidence to determine that staff has not provided access to former resident's belongings. Therefore , the above allegation is UNSUBSTANTIATED at this time.
Exit interview conducted. 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: 08/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021

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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