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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609814
Report Date: 10/29/2022
Date Signed: 10/29/2022 02:11:19 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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2021 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20211115151602
FACILITY NAME:LAND OF PEACE 2FACILITY NUMBER:
197609814
ADMINISTRATOR:ZAKHARYAN, TIGRANFACILITY TYPE:
740
ADDRESS:6636 SALE AVENUETELEPHONE:
(818) 704-9174
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 6DATE:
10/29/2022
UNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Sona Muradyan - AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff did not meet the incontinence needs of resident(s) in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit at this facility to further investigate the above allegation. LPA met with administrator Sona Muradyan and explained the reason for the visit.

LPA conducted physical plant tour at 9:22 AM, requested copies of facility documents at 10:00 AM and interviewed residents and staff between 10:30 AM to 1:00 PM.

Regarding the allegation that staff did not meet the incontinence needs of resident(s) in care. It was alleged that on the morning of 11/10/21, two (2) of the residents were "covered with urine and feces from head to toe". LPA's record review today at around 1:00 PM revealed that the staff are changing the diapers of incontinent residents regularly and as needed. LPA's interview with staff today at 11:00 AM today also revealed that during the period in question, staff did not witness any resident being soiled at anytime the staff was on duty at the facility. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2022
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
Control Number 31-AS-20211115151602
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LAND OF PEACE 2
FACILITY NUMBER: 197609814
VISIT DATE: 10/29/2022
NARRATIVE
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(continued from LIC 9099)

LPA's interview with the administrators between 10:30 AM to 11:00 AM also revealed that they did not receive any report of any resident being soiled especially during the time period in question. LPA's interview with three (3) aware residents between 10:30 AM to 1:00 PM revealed that the staff regularly changed their diapers and as needed.

Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted, copy of this report issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3