197609875-7-15-2020-31-AS-MVAO-BS7S5C-20200805133408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609875
Report Date: 07/15/2020
Date Signed: 07/15/2020 03:56:03 PM

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
06/25/2020 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20200625160616

FACILITY NAME:	WINNETKA HOME CARE		FACILITY NUMBER:	197609875
ADMINISTRATOR:	CHILIAN, HRIPSIME		FACILITY TYPE:	740
ADDRESS:	19733 HEMMINGWAY STREET		TELEPHONE:	(818) 429-0797
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	6	CENSUS: 6	DATE:	07/15/2020
		UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Hripsime Chilian		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Facility does not provide resident a comfortable and safe environment

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith initiated a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Hripsime Chilian.
LPA previously conducted a visit on 6/30/2020 regarding the allegation above. It is alleged that resident #1 (R1) was not afforded a comfortable and safe environment due to their roommate harassing them and facility staff doing nothing to solve the situation. LPA conducted interviews with R1, facility staff, Long-Term Care Ombudsman (LTCO), and R1's social worker. Interview with R1 reveal that they feel the facility does provide a safe environment and is happy being at the facility. There was an issue with R1's roommate but the administrator has stepped in and remedied the situation. Based on interviews conducted this allegation is deemed Unsubstantiated at this time. A telephonic exit interview was conducted with the administrator and a hard copy was provided via email for signature.

Unsubstantiated

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: 07/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2020

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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