197610054-1-12-2023-31-AS-NMAN-CUSVY2-20230817165026

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610054
Report Date: 01/12/2023
Date Signed: 01/12/2023 12:28:22 PM

Unsubstantiated

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
01/10/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230110153807

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: 2	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Khatchik Danielian		TIME COMPLETED:	12:37 PM

ALLEGATION(S):

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Staff member is physically abusing resident in care.

INVESTIGATION FINDINGS:

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At 11:10 a.m. on 01/12/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with Administrator and disclosed the reason for the visit. Regarding the allegation above, it was alleged Resident #1 (R1) was physically abused by staff at the facility. LPA interviewed a resident at 11:12 a.m., staff at 11:45 a.m., and family at 12:15 p.m. on 01/12/2023. LPA conducted a record review at 11:55 a.m. on 01/12/2023 and a a file review at 8:00 a.m. on 01/12/2023. From interviews, Resident #2 (R2) reported no abuse had occurred to them. Staff #1 (S1) stated that R1 hit them while S1 was providing assistance. S1 blocked further hits with their hand, and Staff #2 (S2) witnessed the interaction. R1’s family member stated R1 may have dreamt the encounter and noted R1’s tough attitude. From file review, another unsubstantiated allegation of abuse towards R1 came from a different licensed facility on 12/29/2022 as part of complaint investigation #31-AS-20221229154813. Based on record review, file review, and interviews, 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 UNSUBSTANTIATED at this time.
Exit interview conducted. Copy of report provided. Appeal rights discussed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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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