197610054-12-21-2022-31-AS-NRED-CMBTDQ-20221221133843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610054
Report Date: 12/21/2022
Date Signed: 12/21/2022 01:41:33 PM

Document Has Been Signed on 12/21/2022 01:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	LEO'S ASSISTED LIVING II		FACILITY NUMBER:	197610054
ADMINISTRATOR:	ARAKELIAN, ARMINE		FACILITY TYPE:	740
ADDRESS:	7567 BOVEY AVENUE		TELEPHONE:	(310) 292-2992
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 3	DATE:	12/21/2022
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Anna Gharibyan and Khatchik Danielien		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An Informal Conference was conducted today at the Woodland Hills-South Adult and Senior Care Regional Office. This Informal Conference was held to discuss recent deficiencies and provide guidance to ensure future compliance. Prior to the meeting, Licensee was given the chance to review the facility file. Present at today's meeting were the following: · Anna Gharibyan – Licensee - Khatchik Danielian - Administrator - Cassandra Harris, Licensing Program Manager (LPM) · Nicholas Reed, Licensing Program Analyst (LPA) The informal conference process was explained to the Licensee. The Licensee was also informed that this Informal Conference is a part of the administrative action process. Further citations may result in a Non-Compliance Conference, which could lead to a referral to the Department's Legal Division for possible license revocation or other administrative actions. BRIEF HISTORY: The facility has been in operation since licensure on 08/26/2020. Component II was waived due to the applicant/Administrator on file Sargis Ayvanyan having experience in a licensed facility in good standing (Tarzana Senior Living, Inc. – 197609918). The Licensee has also operated Leo’s Assisted Living (197609916) since 03/05/2020.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: LEO'S ASSISTED LIVING II	FACILITY NUMBER: 197610054
	VISIT DATE: 12/21/2022

NARRATIVE

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· On 07/14/2021 LPA Patrick Shanahan conducted an annual inspection with Licensee’s husband Leo Sayadyan.
On 08/30/2022 LPA Nicholas Reed conducted an annual inspection with Licensee’s husband Leo Sayadyan. LPA Reed later checked the Guardian system and discovered Leo Sayadyan was not associated to the facility. Leo also did not have a criminal background check on file, nor was he listed on the facility’s LIC 500.
· On 09/28/2022 LPA Reed conducted an unannounced complaint visit. LPA discovered that the staff present, Egda Pastora Castro, did not have a criminal background clearance. Egda signed the report as “Sofia Hernandez”. When asked who the boss was, Egda provided LPA with the phone number for Anna Hakobyan. Anna was issued a permanent exclusion from CDSS-CCLD activities on 09/30/2021. The investigation resulted in a deficiency for lack of resident records. The deficiency has yet to be corrected, and daily civil penalties for a failure to correct the deficiency have accrued since 10/28/2022 in the amount of $100/day.
· On 09/29/2022 LPA Reed conducted an unannounced case management visit to address staff without criminal background clearances. The LIC 500 was not current. From an interview, Egda Pastora Castro stated she had worked at the facility for four days. Therefore, LPA issued a civil penalty in the amount of $100/day for four days of working without a criminal background clearance. Egda’s criminal background clearance was transferred on 10/01/2022.
· On 10/27/2022 LPA Reed conducted an announced case management visit. LPA notified Administrator Armine Arakelian of the visit with the intention to meet Administrator and correct deficiencies. The Administrator did not arrive as expected. LPA observed staff Eydi Garcia in the facility. A criminal background clearance was submitted for Eydi on 10/01/2022 but was still “In Process”. Eydi was not cleared to be in the facility. Administrator Armine was not present for 4 out of 4 facility visits by LPA Reed, so LPA issued a deficiency for Administrator qualifications. LPA also issued a deficiency for the lack of personnel files. The deficiency has yet to be corrected, and daily civil penalties for a failure to correct the deficiency have accrued since 11/26/2022 in the amount of $100/day.
· On 11/08/2022 LPA Reed conducted an unannounced case management visit and observed medication accessible and removed from its original container. The deficiency was cited.
· On 11/09/2022 LPA Reed conducted an unannounced case management visit to address staff’s inability to communicate with residents in English. The deficiency was cited and corrected on 12/08/2022.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: LEO'S ASSISTED LIVING II	FACILITY NUMBER: 197610054
	VISIT DATE: 12/21/2022

NARRATIVE

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· On 12/08/2022 LPA Reed conducted an unannounced POC visit to address the deficiencies from 09/29/2022 and 10/27/2022. The deficiencies were not corrected and have not been corrected to this day. Resident records and staff files are still incomplete.

o LPA Reed has never met with Armine Arakelian in person in 7 out of 7 facility visits.

o Resident records and personnel files are incomplete.

o No deaths or hospice admissions have been reported.

o The facility’s first resident was never reported.

Anna noted that she had a family emergency in October, and Administrator Armine had COVID. Therefore, the two had limited participation in facility operations during October and November 2022. Anna noted Armine's estimated date of termination was 10/10/2022, at which point Dinah Pasco served as facility Administrator. Dinah was the Administrator until 12/05/2022 when Khatchik took over.

Administrator Khatchik stated a resident was admitted to hospice yesterday. LPA Reed informed the Administrator of reporting requirements for the resident's hospice admission.

Licensee, Administrator, and LPA reviewed Health and Safety Code 1569.682 regarding facility closure.
Administrator Khatchik noted the license application was submitted to his consultant Sergey on 12/16/2022.

LPM reviewed background information for the licensee, former administrators, and current administrator. All parties discussed the change of ownerships at Oasis Senior Living (#197610233) and Leo's Assisted Living #2.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC809 (FAS) - (06/04)

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