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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609823
Report Date: 06/11/2021
Date Signed: 09/27/2021 09:55:08 AM



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
06/04/2021 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20210604161822
FACILITY NAME:ALALIK CARE HOMEFACILITY NUMBER:
197609823
ADMINISTRATOR:ARZUMANYAN, HARUTYUNFACILITY TYPE:
740
ADDRESS:11152 WOODLEY AVETELEPHONE:
(818) 818-1808
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 5DATE:
06/11/2021
UNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Harutyun Arzumanyan, AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
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5
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8
9
Staff hit resident
INVESTIGATION FINDINGS:
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5
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9
10
11
12
13
This is the amended copy of the licensing report previously issued on 06/11/21. This report was amended to add additional information regarding the complaint investigation.

Licensing Program Analyst (LPA) Rosaura Valenzuela initiated a complaint investigation for the allegation listed above. LPA met with Harutyen Azumanyan, Administrator. The purpose of the visit was discussed. It was reported that facility staff hit resident #1 (R1). To investigate the allegation on 06/11/2021 between 11:30am and 12:30pm, LPA interviewed facility residents and staff. Three (3) out of five (5) residents interviewed revealed that they have not seen staff hitting R1 or other residents. All residents feel safe at this time at the facility. Staff interviewed denied hitting any residents. Between 12:30pm and 1:00pm, LPA Valenzuela requested various facility records. A review of records did not reveal any information to support the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
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
Control Number 31-AS-20210604161822
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: ALALIK CARE HOME
FACILITY NUMBER: 197609823
VISIT DATE: 06/11/2021
NARRATIVE
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During the visit, LPA discussed with Administrator Tittle 22 Reporting Requirements. It is imperative that any and all incidents pertaining to residents in care be reported to licensing within 24 hours and that a report be sent to licensing within seven days of the occurrence.


Exit interview conducted. A copy of the report was given to Administrator and signature was obtained.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2