197609916-4-13-2023-29-AS-JAPL-CRVLWS-20230516090733

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609916
Report Date: 04/13/2023
Date Signed: 04/13/2023 04:07:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
04/16/2021 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20210416095340

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: 2	DATE:	04/13/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Anna Gharibyan, Licensee		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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1. Facility staff left resident on the floor for an extended period of time
2. Facility staff speak inappropriately to residents
3. Facility staff left resident in soiled clothing for an extended period of time
4. Facility staff left residents unsupervised

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to further investigate the above allegations and was let into the home by Roza Sahakyan, Staff. Irene Saroyan, Administrator was contacted by staff and was advised that Licensing was on the premises. Administrator was not able to be onsite due to personal reason and participated via telephone. Anna Gharibyan, Licensee arrived at 9:58am to conduct the visit.

Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, LPA Kelly Dulek conducted the initial complaint investigation telephonically with Armine Arakelian, the facility Administrator at 2:37pm on

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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-20210416095340

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEO'S ASSISTED LIVING	FACILITY NUMBER: 197609916
	VISIT DATE: 04/13/2023

NARRATIVE

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4/26/21. Also present during the virtual visit was licensee representative Anna Gharibyan. A FaceTime video call was also initiated at 3:35PM to conduct a virtual tour of the facility. There were no health and safety concerns identified during the virtual visit. LPA Dulek requested copies of the facility staff schedule, Resident #1’s physician’s report and needs and service appraisal, along with staff #1’s LIC 501 to be emailed to LPA by close of business on 4/27/21. It was determined on the initial visit that further investigation was needed to make a finding for the above allegations.

On today's visit LPA Yee conducted face to face interviews with the Licensee and Administrator at 9:25am, Resident #2 at 12:30pm, Resident #3 at 12:48pm, telephone interview with Staff #1 and reviewed files for Resident #1 - Resident #3.

Per information received during the investigation regarding Allegation #1 - Facility staff left resident on the floor for an extended period of time. Staff #1 denied that Resident #1 was left on the floor for an extended period of time. Resident #1 is bedridden and was not on the floor. However, per Resident #3, there was an incident where Resident #1 was found sitting on the floor and was picked up within minutes, with assistance from staff and resident.. Resident #1 is a nice guy per Resident #3

In regards to Allegation #2- Facility staff speak inappropriately to residents. Per interviews conducted, staff do not speak inappropriately or mistreat the residents. It is alleged that Staff #2 said to leave Resident on the floor to die. Staff #2 stated that as a caregiver, they would never say to leave a resident to die on the floor. Per the residents, staff are never disrespectful or do not mistreat them. Staff sometimes speak loud but it is so that the residents can hear what is being said. Staff will even speak directly into the resident's ear so that they can hear them..

Per information received during the investigation regarding Allegation #3 - Facility staff left
resident in soiled clothing for an extended period of time - staff deny the allegation. Per

Continued on LIC9099-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210416095340

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEO'S ASSISTED LIVING	FACILITY NUMBER: 197609916
	VISIT DATE: 04/13/2023

NARRATIVE

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staff, residents are checked every two hours and there is awake staff at night to ensure that the residents are changed. Interview with Resident #2 confirmed that the residents are checked every two hours or as needed and there are no incontinent issues. Resident #2 is also able to take care of own needs. Per the Administrator, the family and hospice provides the diapers. Per inspection of the outside storage cabinet, there were many cases of diapers observed.

In regards to Allegation #4 - Facility staff left residents unsupervised. Per information received, the facility normally has 2 staff working per shift. There was only one staff observed on today's visit due to one staff being out on an emergency. Since the facility census is 2, another staff was not called in. Per interviews conducted with the Administrator and Licensee, the residents are not left unsupervised.

Based on the information received during the investigations, the finding for the above allegations are UNSUBSTANTIATED. No citations were issued on today's visit

Exit interview was conducted with the Licensee and a copy of the report was provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC9099 (FAS) - (06/04)

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