197609927-9-1-2021-31-AS-NGID-CLXMYV-20221209090202

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609927
Report Date: 09/01/2021
Date Signed: 09/01/2021 07:15:01 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 Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20210825085720

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:	DATE:	09/01/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Anzhelika Alikhanyan, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff mismanaged a resident's medication
Staff failed to meet resident's incontinence needs
Facility staff left resident in wheelchair
Staff failed to meet the resident's hygiene needs

INVESTIGATION FINDINGS:

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At approximately 9:20 am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit to the above facility. Upon arrival LPA was greeted by staff on duty. The Administrator arrived shortly after and the LPA informed her of the reason for the visit.

Allegation: Facility staff mismanaged a resident's medication.
LPA was provided with proof of text messages between the Administrator and R1's POA. It was revealed that the POA did not deliver the medications on a timely manner. Moreover, LPA interviewed #1 through #4 residents. LPA attempted to interview two other residents, but was unable to do so since they were sleeping. All four (4) residents confirmed that they never missed their daily medication dose.

(CONT. on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
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-20210825085720

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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Allegation: Staff failed to meet resident's incontinence needs
LPA interviewed residents, at approximately, 10:35am and residents #1 through #4 stated that staff always meet their needs, if needed, and they had no issues. LPA also observed all six (6) residents being clean, well groomed and smelled good. Facility was observed to be clean and free of any odors.

Allegation: Facility staff left resident in wheelchair.
LPA observed two (2) out of six (6) residents on a wheelchair. LPA interviewed two (2) residents and was informed that they can independently transfer themselves from a wheelchair onto the bed, but if ever needed any help, facility staff was available to provide help in a timely manner.

Allegation: Staff failed to meet the resident's hygiene needs.
LPA interviewed four (4) residents and was informed that facility staff always takes good care of them (pull-ups being changed every 2 hours or as needed, clean clothes and well groomed) and upon touring the facility LPA observed one of the residents heading towards the bathroom and being assisted by staff. LPA also observed the entire facility being clean and free from odor.

Based on the interviews, copies of documents provided by the facility and the LPAs observation, LPA found all four (4) allegations are Unsubstantiated.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
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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