197609829-8-30-2021-29-AS-KBUY-C7E235-20211001170146

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609829
Report Date: 08/30/2021
Date Signed: 08/30/2021 09:28:34 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2020 and conducted by Evaluator Salia Walker

COMPLAINT CONTROL NUMBER: 29-AS-20200505090406

FACILITY NAME:	ARARAT BOARD AND CARE		FACILITY NUMBER:	197609829
ADMINISTRATOR:	SARGSYAN, KARINE		FACILITY TYPE:	740
ADDRESS:	6614 TEESDALE AVE		TELEPHONE:	(818) 624-4180
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 6	DATE:	08/30/2021
		UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Mariam Panadzhyan, Licensee		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Facility fails to provide resident adequate care and supervision
Resident is not being adequately fed
Facility does not supply resident towels and toilet paper

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Salia Walker conducted a subsequent complaint visit to issue final findings for a complaint investigation conducted by LPA Diaz.

On the allegation: Facility fails to provide resident adequate care and supervision. LPA Diaz reviewed facility documents and conducted interviews with staff and residents. LPA interviewed staff on 5/19/21 at 3:40pm and on 5/20/21 at 7:10am and 7:30pm. LPA interviewed staff on 6/21/21 at 4:10pm. LPA interviewed residents on 5/21/21 at 6:13pm and 6:23pm. LPA interviewed residents on 6/21/21 at 3:15pm and attempted to interview residents at 2:55pm, and 3:17pm. All staff stated there are three caregivers working at the facility, and all caregivers provide adequate care and supervision to the residents. All residents interviewed stated that they like the staff, and the staff provides resident care and supervision, and there are no problems in the facility. Based on the evidence gathered through interviews, and observation, the allegation is deemed unsubstantiated at this time.
Continue on LIC9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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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Control Number 29-AS-20200505090406

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: ARARAT BOARD AND CARE	FACILITY NUMBER: 197609829
	VISIT DATE: 08/30/2021

NARRATIVE

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On the allegation: Resident is not being adequately fed. All staff interviewed stated that the facility provides 3 meals a day, and snacks are given in between meals. All staff stated that the facility serves a variety of food such as eggs, cheese potatoes, veggies, fruit, oatmeal, meatballs, chicken, carrots, broccoli and tomatoes. Staff stated that the facility serves different types of stews/soups and the residents have not made complaints about the food. If the resident does not want the food that is being served, an alternative meal is prepared for the resident. All residents stated, the food is good, and the facility provides a variety of food. The residents can tell the staff if they do not like a meal so the staff can bring the resident a meal they like. LPA reviewed the facility menu, which illustrates a variety of food offered to the residents. LPA toured the facility and observed a variety of food such as eggs, cheese, meats, veggies, and fruits. LPA also observed food cooking on the stove. The food cooking was a stew with and meat and vegetables. Based on the evidence gathered through interviews, observation and records reviewed, the allegation is deemed unsubstantiated at this time.

On the allegation: Facility does not supply resident towels and toilet paper. All staff stated that the facility has a supply of toilet paper, and the toilet paper is regularly stocked in the resident’s bathroom. All staff stated that laundry is done daily, and clean towels are placed in the bathrooms and the resident’s rooms. All residents stated that facility provides clean towels and toilet paper without any issues. LPA toured the facility and observed a full supply of toilet paper in the storage shed and observed toilet paper inside the resident’s bathrooms. LPA also observed 5 clean towels in a resident’s room, stored inside the dresser drawer. Based on the evidence gathered through interviews, and observation, the allegation is deemed unsubstantiated at this time.

Exit interview, copy of report issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC9099 (FAS) - (06/04)

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