197609953-10-29-2024-29-AS-KHEN-DAKUT3-20241031155116

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609953
Report Date: 10/29/2024
Date Signed: 10/29/2024 08:02:03 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
02/07/2023 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20230207135308

FACILITY NAME:	GOLDEN AGE ASSISTED LIVING		FACILITY NUMBER:	197609953
ADMINISTRATOR:	SIRANUSH ALVADZHYAN		FACILITY TYPE:	740
ADDRESS:	11749 WELBY WAY		TELEPHONE:	(818) 433-4432
CITY:	NORTH HOLLYWOOD	STATE:	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 6	DATE:	10/29/2024
		UNANNOUNCED	TIME BEGAN:	10:24 AM
MET WITH:	Siranush Alvadzhyan, Administrator		TIME COMPLETED:	08:15 PM

ALLEGATION(S):

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1. The facility did not provide ‘awake night staff’ as agreed upon prior to admission.
2. Facility staff failed to ensure that the resident was assisted with the self-administration of their medication as prescribed
3. Staff did not pick up the resident’s medication timely from the pharmacy
4. Resident’s hygiene needs were not met
5. Staff fed resident too quickly which led to aspiration pneumonia
6. Staff failed to acknowledge residents' food preferences

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to conduct further investigation for the above allegations and to deliver findings of the investigation and was let into the home by Karine Khachatryan, Staff. Siranush Alvadzhyan, Administrator was contacted by staff via telephone and advised of LPA Yee's visit. She arrived at 10:46am to conduct the visit. The reason for today's visit was explained.

On the initial visit conducted on 2/16/2023, LPA Yee conducted interview with the Administratrator at 9:54am - 1:15pm, staff from 01:29 pm - 2:29pm and reviewed facility files beginning at 2:35pm - 3:10pm and obtained copies of facility documents relevant to the complaint. Residents were not interviewed on today's visit due to time constraints.

On today's visit, LPA Yee conducted another interview with the Administrator at 10:55am, Staff #1 at

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

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 4

Control Number 29-AS-20230207135308

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GOLDEN AGE ASSISTED LIVING	FACILITY NUMBER: 197609953
	VISIT DATE: 10/29/2024

NARRATIVE

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12:34pm, Resident #2 at 1:35pm, Resident #3 at 1:40pm, Resident #4 at 2:12pm, Resident #5 at 2:18pm and attempted to interview Resident #6 at 1:33pm and was unsuccessful. Resident #1 was never interviewed as the resident was no longer residing at the home when the complaint was received. Copies of facility documents were collected throughout the visit.

Per information regarding allegation #1 - The facility did not provide ‘awake night staff’ as agreed upon prior to admission. Per review of the facility staff schedule, the facility has a awake staff who works the night shift from 8pm to 8am. Per interviews conducted, the staff who work the night shift, is awake and does room checks every 2-3 hours. Night staff also monitor residents who need to be observed depending on the needs of the resident. Per interviews conducted, Resident #1 would sleep for an hour and was awake most of the night and was monitored and supervised by staff. The facility does not have live in staff. There was insufficient evidence to support the allegation that the facility did not provide awake night staff, therefore the allegation is unsubstantiated.

Per interviews conducted with staff and residents regarding allegation #2 - Facility staff failed to ensure that the resident was assisted with the self-administration of their medication as prescribed, residents interviewed stated that the facility staff store all their medications and dispense their medications in a timely manner. Residents interviewed were able to tell LPA Yee how many times during the day that they received their medications and have indicated that they have not had any issues with their medications. Per staff interviewed, medications prescribed on a cycle are dispensed to the residents as ordered by the physician. Resident #1 was prescribed Naproxen 375mg - 1 tab 2 twice a day and the resident was given the medication as prescribed. On 10/6/23, Temazepam was picked up by the Administrator and given to Resident #1 at bed time. The facility staff administered both medication as prescribed. Per interviews conducted, staff do not modify doctors orders and administer medications as prescribed. Changes are made to physician's order only if the doctor orders the change in writing. The staff indicated that they don't have any reason not to give the residents their medications. LPA Yee was not able to obtain sufficient evidence to support the allegation that facility staff failed to ensure that the resident was assisted with the self administration of their medication as prescribed, therefore the allegation is unsubstantiated at this time.

Continued on LIC9099-C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230207135308

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GOLDEN AGE ASSISTED LIVING	FACILITY NUMBER: 197609953
	VISIT DATE: 10/29/2024

NARRATIVE

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Allegation #3 alleges that Staff did not pick up the resident’s medication timely from the pharmacy and per interviews conducted with the Administrator, reveals that Resident #1 was prescribed Temazepam on 10/5/22. The pharmacy where the physician's order was sent electronically, did not have the medication in stock and had to order the medication and it would not be available until 10/6/22 and could not be picked up the same day. However, the family member of Resident #1, states that the physician's order was sent on 10/4/22 to the pharmacy and would have been ready for pick up the same day. It is unknown when the physician's order was actually transmitted to the pharmacy or if Temazepam was in stock on 10/4/22 for the same day pickup or if the prescribed medication would have had to be ordered as was the case on 10/5/22. The medication pickup the same day was delayed not due to the failure of the Administrator to pick up the medication but due to availability of the medication. There was insufficient evidence to support the allegation that staff did not pick up the resident's medication timely from the pharmacy, therefore the allegation is unsubstantiated at this time.

The complaint continues to allege in allegation #4 that Resident’s hygiene needs were not met. Per interviews conducted with the Administrator, Staff #1 and residents, the residents are bathed 2 times a week or as requested or as needed. The residents clothing are changed every morning and changed into pajamas for bed. They ensure residents brush their teeth and the caregivers comb all the residents' hair. Sometimes residents' won't allow staff to help them. It is alleged that Resident #1 was observed to be disheveled and had food stuck in their teeth and this was not the norm for the resident. Per interviews conducted with staff, the resident would be bathed 2 times a week, changed and their hair combed. Resident #1 had insomnia and laying down would have given the resident the appearance of not being cleaned or having their hygiene needs met. The resident's appearance is not sufficient evidence to conclude that it was due to lack of hygiene care. There is insufficient evidence to support the allegation that the Resident's hygiene needs were not met, therefore the allegation is unsubstantiated at this time.

Allegation #5 of the complaint alleges that Staff fed resident too quickly which led to aspiration pneumonia. Per review of medical records the resident was sent to the hospital on 10/8/22 for coughing, low oxygen and general weakness. It was determined at the time of the hospitalization that the primary diagnosis was that Resident #1 had aspiration pneumonia. The family member hypothesizes that the cause of the aspiration pneumonia was due to the facility staff being impatient and feeding Resident #1 very fast. Per this investigation, there was no conclusive evidence to establish that the staff's actions was the cause of

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20230207135308

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GOLDEN AGE ASSISTED LIVING	FACILITY NUMBER: 197609953
	VISIT DATE: 10/29/2024

NARRATIVE

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Resident #1 aspiration pneumonia. Aspiration pneumonia can develop from just swallowing ones own saliva or vomit or coughing while eating and causing food to get into the lungs or other reasons. The investigation did not reveal that the aspiration pneumonia was the result of staff's action of feeding the resident fast. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

The last allegation on the complaint - allegation #6 the facility Staff failed to acknowledge residents'
food preferences. Per investigation of the allegation, Resident #1 ate everything that was given to them. Resident did not refuse the food. Residents can also ask for something different if they do not like the food offered on the menu. Per the Administrator, family member never discussed food options for Resident #1 with her and was not aware that there was a problem with the food. Per review of the menu, the facility offers a variety of foods and also offers other food choices for birthdays and holidays. There was insufficient evidence to support the allegation that the facility failed to acknowledge residents' food preferences, therefore the allegation is unsubstantiated at this time.

Although all the above allegations may have have happened or is valid, there was not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the all the allegations were deemed UNSUBSTANTIATED at this time.

No deficiencies were cited on today's visit.

Exit interview was conducted and a copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC9099 (FAS) - (06/04)

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