197609990-11-27-2024-31-AS-NMAN-DDSS2N-20250211122950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609990
Report Date: 11/27/2024
Date Signed: 11/27/2024 10:48:17 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
11/06/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20241106092013

FACILITY NAME:	AMENA LOVE BOARD AND CARE		FACILITY NUMBER:	197609990
ADMINISTRATOR:	JONES, MERCER		FACILITY TYPE:	740
ADDRESS:	10751 VIKING AVE		TELEPHONE:	(747) 239-3247
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91326
CAPACITY:	6	CENSUS: 3	DATE:	11/27/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Mercer Jones		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff conduct poses a risk to residents in care

INVESTIGATION FINDINGS:

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At 9:30 a.m. on 11/27/24 Licensing Program Analysts (LPAs) Nicholas Reed and Nadia Shahbazian conducted an unannounced complaint visit. LPAs met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA Reed conducted an initial visit on 11/14/24 and interviewed staff and residents between 11:30 a.m. and 12:45 p.m., toured the facility inside and out at 12:00 p.m., and conducted a record review of pertinent records, including but not limited to a medical assessments, care plans, and staff and client rosters at at 3:00 p.m. Today, LPAs toured the facility inside and out at 10:10 a.m., interviewed Staff #1 (S1) at 10:15 a.m., and tested facility call systems at 10:30 a.m.

Regarding the allegation "Staff conduct poses a risk to residents in care" it was alleged S1 made lengthy and loud phone calls at night which distracted them from caring for residents. Interview with Resident #1 (R1) at 12:30 p.m. on 11/14/24 revealed that they use the bathroom about four (04) times each night.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024

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-20241106092013

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: AMENA LOVE BOARD AND CARE	FACILITY NUMBER: 197609990
	VISIT DATE: 11/27/2024

NARRATIVE

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R1 is able to do so on their own and prefer to do so independently. Interview with Resident #2 (R2) at 12:15 p.m. on 11/14/24 revealed that all residents have pendants which they can use if they need staff assistance. R2 stated they have seen staff in the hallways at night supervising residents. Interviews with three (03) out of three (03) residents revealed all of their needs throughout the days and nights have been met. No residents have heard loud conversations or swearing. No residents have been bothered at night. Record review revealed that two (02) out of three (03) residents require assistance transferring in and out of bed. All residents are able to communicate their needs, and no residents have dementia. Tests of the facility call systems today deemed all pendants functioning and operational. Interview with S1 revealed they are always available to assist residents. S1 responds to call system calls within two (02) minutes. S1 helps R2 often at night, and R1 and Resident #3 (R3) are in bed for most of the might. S1 confirmed there was a misunderstanding from a phone call they had, but the phone call did not distract them from their duties.

Based on observations, interviews, and record review, staff adequately provide care and supervision to all residents during the day and night. Staff conduct does not pose a risk to residents in care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024

LIC9099 (FAS) - (06/04)

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