197609916-12-12-2023-29-AS-DPEA-CYN2FE-20231218162125

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609916
Report Date: 12/12/2023
Date Signed: 12/12/2023 03:33:26 PM

Unsubstantiated

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
11/14/2023 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20231114162623

FACILITY NAME:	LEO'S ASSISTED LIVING		FACILITY NUMBER:	197609916
ADMINISTRATOR:	IRENE SAROYAN		FACILITY TYPE:	740
ADDRESS:	15932 VOSE STREET		TELEPHONE:	(818) 510-0141
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY:	6	CENSUS: 2	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Anahit Matevosyan - Caregiver		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Resident sustained unexplained bruising while in care.

Staff are unable to communicate with residents due to a language barrier

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to investigate the allegations listed above. During today’s visit, LPA met with caregiver Anahit Matevosyan and explained the reason for the visit. Administrator Irene Saroyan was contacted during the visit and stated they are not able to attend the visit due to a previous appointment, but caregiver Anahit will sign in their place.

On 11/20/2023, from 12:45 p.m. – 02:30 p.m., LPA initiated an unannounced complaint investigation for the allegations listed above. During the visit, LPA toured the physical plant, interviewed staff, residents and reviewed and obtained pertinent documents relevant to the investigation. Additionally, LPA attempted to contact the reporting party on 11/15/2023, 11/16/2023,12/07/2023 and 12/12/2023, but was unsuccessful. Today LPA conducted physical plant, interviewed staff and one resident.

Continued on 9099-C

Unsubstantiated

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: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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-20231114162623

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: 12/12/2023

NARRATIVE

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Continued from 9099

It was reported that Resident #1 (R1), sustained unexplained bruising while in care, as it was alleged that when R1 was relocated to a new facility (Magidow Family Home LIC #191840767) and assessed, the Administrator for that facility observed bruising on R1's back. On 12/12/2023 at approx. 01:00 p.m., LPA conducted telephone Interview with Administrator of Magidow Family Home, Birdie King, who revealed that R1 resided at their home for approximately 2 weeks and they never observed any bruising on the back of R1. Additionally interviews conducted and records reviewed at this facility revealed residents are checked every morning for any changes physically and they are typically bathed two times a week. No resident has ever been observed with bruises on their back. Based on information gathered over the course of the investigation the Department does not have sufficient evidence to confirm this allegation occurred. Therefore the allegation that R1 sustained unexplained bruising while in care has been deemed Unsubstantiated at this time.

It was reported that Staff are unable to communicate with residents due to a language barrier, as it was alleged that staff was not able to understand R1. LPA's interview with two (2) residents revealed that each resident did not express any immediate or potential concerns with communicating with staff at the facility. LPAs interviews with staff revealed they were able to communicate regarding facility business, resident care needs and questions related to emergency response. Based on the information gathered over the course of this investigation, the department does not have sufficient evidence to determine this allegation occurred. Therefore the allegation that Staff are unable to communicate with residents due to a language barrier has been deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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