197609876-9-7-2021-31-AS-NGID-C7CTCH-20210930143645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609876
Report Date: 09/07/2021
Date Signed: 09/07/2021 11:32:44 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
09/02/2021 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20210902120744

FACILITY NAME:	A-1 ASCENDED SENIOR CARE		FACILITY NUMBER:	197609876
ADMINISTRATOR:	TOPCHYAN, HARUT		FACILITY TYPE:	740
ADDRESS:	16444 GERMAIN STREET		TELEPHONE:	(818) 667-4915
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	09/07/2021
		UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Harut Topchyan/ Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Resident was not afforded privacy while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), arrived at the home at 8:30 am and was greeted by the facility staff. Upon entry, LPA observed 3 baby video monitors on the kitchen island for 3 clients in care.
At 8:45am, the administrator was contacted via phone and LPA was able to speak with the administrator over the phone. LPA explained the reason for the visit. At 9:00 am, the administrator confirmed that there was no documentation that allowed for cameras in residents room, but did state that all families are aware of the cameras and they are in place at the families request.
At 9:15am, LPA was able to tour the rooms of the residents with cameras in their rooms. Room number 5 is a shared room and resident 3 (R3) was unaware of the camera in the room. When the administrator was asked about this, the administrator confirmed that the camera only focuses on R2's bed and R3 is not in the shot. The administrator stated that all of the family members had requested the cameras but no documentation for them was available.
Based on LPA observation and administrator confirmation of the cameras, this allegation is deemed to be SUBSTANTIATED. Exit interview conducted, deficiencies cited, appeal rights given and report issued.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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 31-AS-20210902120744

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: A-1 ASCENDED SENIOR CARE	FACILITY NUMBER: 197609876
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/14/2021 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1(a)(1) Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The administrator agrees to provide CCL with writen proof from the responsible parties to allow cameras in the room or have the cameras removed by the POC date.
	8 9 10 11 12 13 14	Based on observation and interviews the licensee did not comply with the section cited above by utilizing video camera's in the bedrooms of the facility which poses a potential health, safety risk or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC9099 (FAS) - (06/04)

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