197609923-6-16-2023-29-AS-DPEA-CU9SKG-20230731135639

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609923
Report Date: 06/16/2023
Date Signed: 06/16/2023 01:32:20 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
02/08/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20220208161249

FACILITY NAME:	BASSETT RESIDENTIAL CARE		FACILITY NUMBER:	197609923
ADMINISTRATOR:	TAVITIAN, HRIPSIME		FACILITY TYPE:	740
ADDRESS:	16017 BASSETT ST		TELEPHONE:	(818) 442-5702
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY:	6	CENSUS: 6	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Emma Arutiunian - Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Covid-19 masking protocols are not being followed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to investigate the allegation listed above. Upon arrival LPA met with facility staff and explained the reason for the visit. Administrator Emma Arutiunian arrived shortly after.

On 02/14/2022, the initial complaint visit was conducted between approximately 10:29 a.m. - 1pm. During the visit, LPA conducted physical plant, interviewed staff, residents, resident families, as well as reviewed and obtained copies of pertinent documents relevant to the investigation.

It was alleged that facility is not following COVID-19 masking requirements. Regional office received information from a credible witness that while visiting the facility, they observed that staff were not wearing masks. During the time of the complaint, COVID-19 Ongoing Requirements from Public Health required the use of face masks inside the facility. On 02/14/2022, upon arrival to the facility, LPA observed staff wearing mask however,

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: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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-20220208161249

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: BASSETT RESIDENTIAL CARE	FACILITY NUMBER: 197609923
	VISIT DATE: 06/16/2023

NARRATIVE

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Continued 9099
LPA interview with the staff revealed they recently had a visit from an outside agency who observed Staff 1 (S1) and Staff (S2), not wearing a mask while working with the residents. Based on information gathered throughout the course of the investigation, the Department has sufficient evidence to determine that facility staff were not using face coverings at all time while inside the facility. Therefore, the above allegation that COVID-19 masking protocols are not being followed is deemed SUBSTANTIATED at this time.

Citations Issued. See LIC 9099-D. Appeal Rights discussed and copy of report issued to Administrator.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220208161249

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: BASSETT RESIDENTIAL CARE	FACILITY NUMBER: 197609923
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/19/2023 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	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 when required and to 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 06/19/2023.
	8 9 10 11 12 13 14	Based on 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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	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: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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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
02/08/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20220208161249

FACILITY NAME:	BASSETT RESIDENTIAL CARE		FACILITY NUMBER:	197609923
ADMINISTRATOR:	TAVITIAN, HRIPSIME		FACILITY TYPE:	740
ADDRESS:	16017 BASSETT ST		TELEPHONE:	(818) 442-5702
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY:	6	CENSUS: 6	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Emma Arutiunian - Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Communications to the facility are not being answered in a timely manner

Facility does not have a designated administrator

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to deliver findings for the allegations listed above. Upon arrival LPA met with facility staff and explained the reason for the visit. Administrator Emma Arutiunian arrived shortly after.

On 02/14/2022, the initial complaint visit was conducted between approximately 10:29 a.m. - 1pm. During the visit, LPA conducted physical plant, interviewed staff, residents, resident families, as well as reviewed and obtained copies of pertinent documents relevant to the investigation.

It was reported that Communications to the facility are not being answered in a timely manner, as It was alleged that multiple phone calls concerning the facility were not returned. Interviews with facility staff and Administrator revealed phone calls are always answered and if any are missed, they attempt to return calls in a timely manner as they were received.

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: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20220208161249

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: BASSETT RESIDENTIAL CARE	FACILITY NUMBER: 197609923
	VISIT DATE: 06/16/2023

NARRATIVE

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Continued from 9099

Interviews conducted with families and responsible parties of residents over the course of the investigation revealed that each party did not express any immediate or potential concerns of facility staff not answering their calls or keeping them up to date with their resident in care. Based on information obtained throughout the course of the investigation, LPA could not find sufficient evidence to indicate the allegation had occurred. Therefore the allegation of Communications to the facility are not being answered in a timely manner is deemed Unsubstantiated at this time.

It was alleged that facility does not have a designated administrator. Interviews conducted and records reviewed revealed , at the time of the complaint, Hripsime Tavitian was listed as Licensee and Administrator. Caregiver / House Manager Emma Arutiunian was designated on Licensing form LIC 308 as the staff authorized to receive any documents including reports of inspections and consultations, accusations and civil and administrative processes on the behalf of the Administrator in the event of their absence. Interviews conducted with families of residents in care confirmed Hripsime as Administrator during the time of the complaint. Based on information obtained throughout the course of the investigation, there is not sufficient evidence to confirm the allegation occurred. Therefore, the allegation that facility does not have a designated administrator is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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