197609813-5-6-2022-31-AS-CHAS-CEGTWP-20220516150554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609813
Report Date: 05/06/2022
Date Signed: 05/06/2022 12:57:38 PM

Unfounded

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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2022 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20220506093158

FACILITY NAME:	LAND OF PEACE 1		FACILITY NUMBER:	197609813
ADMINISTRATOR:	ZAKHARYAN, TIGRAN		FACILITY TYPE:	740
ADDRESS:	6624 SALE AVENUE		TELEPHONE:	(818) 704-6828
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	6	CENSUS: 5	DATE:	05/06/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Roselin Finuliar		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff unlawfully evicted a resident while in care

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with the administrator and explained the reason for this visit.
It is alleged that the facility is refusing to accept resident #1 (R1) back into the facility after being hospitalized. LPA conducted interviews with facility staff from 12:10-12:40pm. Information obtained through interviews reveal that R1 does not reside at this facility but does reside at Land of Peace 3 with a facility number of 197609812. This complaint will be addressed at that facility. Based on the information obtained through interviews this allegation is deemed UNFOUNDED, means that the allegation is false, could not have happened, and/or is without a reasonable basis.
Exit Interview conducted.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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 3