<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610054
Report Date: 09/28/2022
Date Signed: 09/28/2022 06:37:43 PM

Substantiated


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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2022 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20220923175322
FACILITY NAME:LEO'S ASSISTED LIVING IIFACILITY NUMBER:
197610054
ADMINISTRATOR:ARAKELIAN, ARMINEFACILITY TYPE:
740
ADDRESS:7567 BOVEY AVENUETELEPHONE:
(310) 292-2992
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 2DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Sofia HernandezTIME COMPLETED:
06:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident records were not maintained at the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 3:45 p.m. on 09/28/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. LPA and staff toured the facility inside and out. No immediate health and safety concerns were observed.

LPA interviewed Staff (#1) and Staff #2 (S2) at approximately 4:15 p.m. LPA interviewed Resident #1 (R1) at 4:30 p.m. LPA conducted a record review at 4:45 p.m.

Regarding the allegation above, it was alleged facility staff did not provide records to paramedics. From interviews, S1 confirmed that the resident files were not provided to paramedics. R1 stated paramedics looked at discharge paperwork but no licensing forms. S2 stated that the forms were locked in the facility, but S1 did not have the key to access them. Based on interview, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on LIC 9099-D page.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
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
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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2022 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20220923175322

FACILITY NAME:LEO'S ASSISTED LIVING IIFACILITY NUMBER:
197610054
ADMINISTRATOR:ARAKELIAN, ARMINEFACILITY TYPE:
740
ADDRESS:7567 BOVEY AVENUETELEPHONE:
(310) 292-2992
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 2DATE:
09/28/2022
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Sofia HernandezTIME COMPLETED:
06:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not properly caring for resident
Administrator/Designee unqualified to manage facility
Resident's bed is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Staff not properly caring for resident
Regarding the allegation above, it was alleged that R1’s catheter bag was full and needed changing. From interviews, S1 stated they change R1’s catheter bag multiple times each day as needed. R1 confirmed S1 does a good job of emptying their catheter bag. R1 further stated when paramedics arrived, the catheter bag was only half full, and R1 is satisfied by the care provided. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20220923175322
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEO'S ASSISTED LIVING II
FACILITY NUMBER: 197610054
VISIT DATE: 09/28/2022
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
26
27
28
29
30
31
32
Administrator/Designee unqualified to manage facility
Regarding the allegation above, it was alleged S1 was unable to communicate with paramedics in English. From interviews, S1 stated they spoke with a Spanish-speaking paramedic during the encounter. S2 stated they spoke with paramedics over the phone in English. During today’s visit, LPA observed R1 and S1 communicate successfully in Spanish. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time.

Resident's bed is in disrepair.
Regarding the allegation above, it was alleged the remote control was broken on R1’s bed. At approximately 4:30 p.m. LPA inspected R1’s bed and observed it was unplugged. The remote and bed functioned properly after plugging it in. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANIATED at this time.

Exit interview conducted. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20220923175322
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEO'S ASSISTED LIVING II
FACILITY NUMBER: 197610054
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2022
Section Cited
CCR
87506(a)
1
2
3
4
5
6
7
87506 Resident Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee will provide a key for staff and designees to access the files. Licensee will also submit copies of resident records for all current residents by the POC due date.
8
9
10
11
12
13
14
Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4