197609793-1-27-2023-29-AS-DPEA-CNM5EQ-20230131185354

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609793
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:43:13 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
12/29/2020 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20201229145543

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:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Emma Arutiunian - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident is being forced to stay at facility.

INVESTIGATION FINDINGS:

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**This is the new amended report that includes additional information for the report issued on 08/17/2021**
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 01/16/2021 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 reported that Resident 1 (R1) is being forced to stay at facility as it was alleged that R1 had expressed to other parties involved that they wanted to go home. LPA’s record review of R1’s facility documents revealed R1 was self-responsible and R1 signed all facility documents upon admission.

Continued on 9099-C

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: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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 29-AS-20201229145543

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SAINT CLAIR ASSISTED LIVING	FACILITY NUMBER: 197609793
	VISIT DATE: 01/27/2023

NARRATIVE

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Continued from 9099

LPA’s records review of physicians report further revealed there was nothing that indicated that stated R1 did not have the mental capacity to sign for themselves. LPAs interview with residents currently in care revealed that all do not feel they are being forced to stay at the facility and all did not express any potential or immediate concerns about residing at this facility. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that R1 is being forced to stay at facility. Therefore , the allegation that R1 is being forced to stay at facility has been deemed UNSUBSTANTIATED at this time.

Exit interview conducted and copy of report left with Administrator.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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