197609916-10-7-2022-29-AS-DPEA-CKESHF-20221021135327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609916
Report Date: 10/07/2022
Date Signed: 10/07/2022 12:42:59 PM

Substantiated

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
08/11/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20220811141449

FACILITY NAME:	LEO'S ASSISTED LIVING		FACILITY NUMBER:	197609916
ADMINISTRATOR:	ARMINE ARAKELIAN		FACILITY TYPE:	740
ADDRESS:	15932 VOSE STREET		TELEPHONE:	(818) 510-0141
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY:	6	CENSUS: 5	DATE:	10/07/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Armine Arakelian - Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff are not following protocols to prevent the spread of COVID-19

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint investigation visit to deliver findings for the above allegation. Upon arrival LPA met with Armine Arakelian - Administrator and explained the reason for the visit.

On 8/11/2022, at approximately, 12:30pm, LPA conducted physical plant, interviewed staff and residents as well as reviewed and obtained copies of pertinent documents relevant to the investigation.

It was alleged that Staff are not following protocols to prevent the spread of COVID-19. Regional office received information from a credible witness that while visiting the facility, they observed that some caregivers were not wearing masks and they were able to enter the facility without being screened by staff. Upon arrival to the facility, LPA observed all staff wearing masks and LPA was also screened at the door and temperature was taken by staff.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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-20220811141449

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: LEO'S ASSISTED LIVING	FACILITY NUMBER: 197609916
	VISIT DATE: 10/07/2022

NARRATIVE

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Continued from 9099
LPA's interview with residents in care revealed there have been multiple occasions where each have not witnessed staff wearing a face covering while servicing residents in care, but most could not recall if screening protocols are being conducted for visitors.

Based on information gathered during this and previous visit the allegation that Staff are not following protocols to prevent the spread of COVID-19 is deemed SUBSTANTIATED at this time.

Citations Issued. See LIC 9099D. Appeal Rights discussed. Exit interview conducted and copy of the report emailed to Administrator.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220811141449

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: LEO'S ASSISTED LIVING	FACILITY NUMBER: 197609916
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/10/2022 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	87468.1(a)(2) Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Licensee agreed to advised staff on wearing masks at all times inside the facility and conduct a training on CA Dept of Public Health Guidance for the use of face coverings and COVID-19 screening protocols and submit proof to LPA via email by end of day 10/10/2022.
	8 9 10 11 12 13 14	Based observations and interviews, the Licensee did not ensure the personal rights of persons in care to live in a safe, healthy, and comfortable home as staff did not wear face coverings at all times while inside the facility, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
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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: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC9099 (FAS) - (06/04)

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