197609927-9-1-2021-31-AS-NGID-CGWV2M-20220802160318

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609927
Report Date: 09/01/2021
Date Signed: 09/01/2021 03:27:35 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2021 and conducted by Evaluator Melissa Ruiz

COMPLAINT CONTROL NUMBER: 31-AS-20210825122154

FACILITY NAME:	ASSISTED SENIOR CARE FACILITY		FACILITY NUMBER:	197609927
ADMINISTRATOR:	ANZHELIKA, ALIKHANYAN		FACILITY TYPE:	740
ADDRESS:	7039 CLAIRE AVE		TELEPHONE:	(818) 988-9724
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 6	DATE:	09/01/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Administrator, Anzhelika Alikhanyan		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Administrator spoke inappropriately to a resident
Facility fees are not printed on Admission Agreement
Facility does not provide appropriate living accommodations for staff

INVESTIGATION FINDINGS:

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At 9:15 am, Licensing Program Analysts (LPA) Melissa Ruiz conducted an unannounced complaint visit to this facility to investigate the allegations mentioned above. LPA was greeted by a staff member (S1) and later met with the Administrator Anzhelika Alikhanyan at approximately 10:15 am. The purpose of this visit was explained. The first allegation states that the administrator spoke inappropriately to a resident. At 10:01 am, LPA began conducting interviews with the Administrator, staff #1 (S1), and four residents (R1-R4). LPA attempted to interview two (2) other residents but was unable to do so since the residents were sleeping. LPA interviewed the Administrator and denies ever speaking inappropriately to any resident. LPA then interviewed staff #1 (S1). S1 states they have never witnessed the Administrator speak inappropriately towards any resident. Lastly, all four (4) residents stated the Administrator has never spoken inappropriately to them. They all said they have a good relationship with the Administrator and staff. They all stated they are happy at the facility.

(cont. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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-20210825122154

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: ASSISTED SENIOR CARE FACILITY	FACILITY NUMBER: 197609927
	VISIT DATE: 09/01/2021

NARRATIVE

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The second allegation states that facility fees are not printed on the Admission Agreement. At 9:30 am, LPA reviewed resident files and found all that all facility fees were specified on Admission Agreements. Relevant documentation was obtained by LPA. Lastly, it is alleged that the facility does not provide appropriate living accommodations for staff. Upon interviewing the Administrator, LPA was informed they do not have live-in staff. Facility has two (2) wandering residents which require a wake night staff. Upon touring the facility, LPA did not observe a designated staff room, all five (5) bedrooms were for resident use.

Upon the completion of this investigation, the above referenced allegations are unsubstantiated. Exit interview conducted, no deficiencies cited.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC9099 (FAS) - (06/04)

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