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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609992
Report Date: 12/13/2024
Date Signed: 12/13/2024 11:20:38 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
01/18/2024 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20240118171047
FACILITY NAME:GEVART A.R.F. INCFACILITY NUMBER:
197609992
ADMINISTRATOR:GHAZARYAN, YERANUHIFACILITY TYPE:
735
ADDRESS:8651 ROSLYNDALE AVETELEPHONE:
(323) 219-5454
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY:4CENSUS: 4DATE:
12/13/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kulwant KaurTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility Staff inflicted humiliation, intimidation, threats or other mental abuse on resident.
Facility Staff physically assaulted Resident.
INVESTIGATION FINDINGS:
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At 10:00 a.m. on 12/13/24 Licensing Program Analysts (LPAs) Nicholas Reed and Nadia Shahbazian conducted an unannounced subsequent complaint visit. LPA met with the assistant administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA Chris Alemoh conducted an initial visit on 01/25/24 conducted a physical plant tour at 10:45 a.m., reviewed records pertinent to the investigation, including but not limited to a physician’s reports, appraisal needs and service plan, admission agreement, client and staff rosters, and police reports, interviewed three (03) out of (03) clients, five (05) out of six (06) staff, and the administrator between 11:45 a.m. and 2:30 p.m. LPA Alemoh also interviewed two (02) staff, the administrator, and client #1 (C1) from Powell House IV (197607040) between 2:30 p.m. and 3:45 p.m. on 01/25/24. On 12/05/24, LPA Reed telephonically interviewed the administrator at 11:15 a.m. and C1 at 11:45 a.m. and performed a file review at 12:00 p.m. Today, LPAs toured the facility at 10:15 a.m. and interviewed the assistant administrator at 10:30 a.m.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
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 2
Control Number 31-AS-20240118171047
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: GEVART A.R.F. INC
FACILITY NUMBER: 197609992
VISIT DATE: 12/13/2024
NARRATIVE
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Regarding the allegation "Facility staff inflicted humiliation, intimidation, threats or other mental abuse on resident." it was alleged Staff #1 (S1) yelled at and threatened C1 in August 2023 and January 2024, the administrator called and harassed C1 in August 2023, and Staff #2 (S2) called C1 names on 01/12/24 and chased C1 out of the home with a fork. Interview with the administrator revealed they called C1 to check on their well being, but the administrator never harassed C1. Interview with S1 on 01/25/24 revealed they never hit, kicked, pushed, or were assaultive towards C1 or any other clients. Interview with S2 revealed staff did not hit C1. S2 made no mention of chasing C1 with a fork or calling C1 names. Interview with Staff #3 (S3) revealed staff have not threatened, hit, spit on clients. Staff also have not gone through client belongings. Interview with Staff #4 (S4) revealed no staff were involved in spitting, yelling, beating up, pushing clients, and instead, C1 was aggressive with staff. Interview with the assistant administrator revealed C1 was never touched by staff nor harassed. LPA Alemoh's interviews with Client #2 (C2), Client #3 (C3), and Client #4 (C4) on 01/25/24 revealed they had never seen staff be rough or physical with clients, spit on clients, or yell at clients. LPAs did not observe any rough, abusive, or inappropriate behavior from staff during today’s visit. File review from 12/05/24 revealed reports submitted by the facility detailed incidents on 12/02/23 and 12/05/23 of C1 destroying property. Based on observations, file review, and interviews, facility staff did not inflict humiliation, intimidation, or threats to clients in care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Facility staff physically assaulted resident” it was alleged S1 pushed and kicked C1 on 12/02/23 and the administrator pushed C1. File review from 12/05/23 revealed the facility submitted a report from 12/02/23 in which C1 destroyed property and made verbal threats. The report made no mention of staff physically abusing C1. Interview with the administrator revealed they never touched nor abused C1. Interview with S1 confirmed they never hit, or touched C1. Interviews with three (03) other staff and three (03) other clients confirmed they had never seen S1 or the administrator physically abuse C1. Based on interviews and file review, facility staff did not physically assault C1. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety hazards were observed during today's visit.

Exit interview conducted. Copy of report provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2