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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609953
Report Date: 08/06/2021
Date Signed: 08/06/2021 11:52:37 AM

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
12/16/2020 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20201216081630
FACILITY NAME:GOLDEN AGE ASSISTED LIVINGFACILITY NUMBER:
197609953
ADMINISTRATOR:SIRANUSH ALVADZHYANFACILITY TYPE:
740
ADDRESS:11749 WELBY WAYTELEPHONE:
(323) 236-2336
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 5DATE:
08/06/2021
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Ruzanna Tonoyan - Head CaregiverTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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9
Staff unable to communicate with resident due to language barrier.

Resident toileting needs are not being met.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the allegations listed above. LPA met with Ruzanna Tonoyan and explained the reason for the visit. LPA spoke with the Administrator who stated Ruzanna is able to sign for the report.
During the course of the investigation, LPA conducted a physical plant tour virtually on 12/24/2020 as well as interviewed Administrator. On 6/11/21 LPA conducted interviews with facility staff and gathered and reviewed facility documentation pertinent to the allegation. On 6/18/2021, LPA conducted interviews with the administrator and residents.
It was alleged, that staff are unable to communicate with resident due to language barrier, LPAs interview with residents revealed most feel they do not have any 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 during this and previous visits, the department does not have sufficient evidence to determine that staff are unable to communicate with resident due to language barrier. Therefore, the above allegation is UNSUBSTANTIATED at this time
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 29-AS-20201216081630
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: GOLDEN AGE ASSISTED LIVING
FACILITY NUMBER: 197609953
VISIT DATE: 08/06/2021
NARRATIVE
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continued from 9099

It was alleged that Resident toileting needs are not being met, LPAs interview with residents revealed that most do not have any concerns with staff assisting them with their toileting needs. During the course of the investigation LPA observed Resident 1 (R1) request Staff 1 (S1) to use the bathroom. S1 went into the bedroom and assisted R1 into the bathroom and waited by the door until R1 requested S1 to return them to their room. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that resident toileting needs are not being met. Therefore the above allegation is UNSUBSTANTIATED at this time.

Exit interview conducted. Report issued and sent via Email.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2