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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610054
Report Date: 01/12/2023
Date Signed: 01/12/2023 11:00:21 AM

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
12/02/2022 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20221202164248
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: 1DATE:
01/12/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Khatchik DanielianTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff is unable to properly communicate with residents due to language barrier.
Facility has inadequate food service.
Staff were unable to provide Paramedics with resident's records.
INVESTIGATION FINDINGS:
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At 9:30 a.m. on 01/12/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with staff and later Administrator and disclosed the reason for the visit.
LPA interviewed residents, staff, and Administrator at 9:45 a.m. on 12/08/2022. LPA conducted a records review at 12:15 p.m. on 12/08/2022. LPA reviewed photographs at 9:35 a.m. on 11/08/2022 and at 5:30 p.m. on 12/07/2022
Regarding the allegation “Staff is unable to properly communicate with residents due to language barrier”, it was alleged Staff #1 (S1) and Staff #2 (S2) did not speak English fluently enough to communicate with residents. From interviews, residents had difficulty communicating with S1 and S2. Residents have used a translator app and written translations from Armenian to English. When interviewed, S1 stated they are taking English lessons, and S2 did not speak sufficient English. The administrator noted that since being hired on 12/05/2022, employees have been hired who effectively communicate with residents, though conditions were different prior. Based on interviews and record review, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on LIC 9099-D.
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: 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)
Page: 1 of 4
Control Number 31-AS-20221202164248
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: 01/12/2023
NARRATIVE
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Regarding the allegation “Facility has inadequate food service”, it was alleged the food served did not meet residents’ nutritional requirements. A similar allegation was investigated on 11/08/2022 and 11/09/2022 in complaint # 31-AS-20221108101558. From interviews, residents were unsatisfied with the food served. The Administrator noted that food quality has improved since their recent hiring. From observations, food served on 12/08/2022 appeared to improve in quality and variety from photos observed on 12/07/2022 and 11/08/2022. Based on observations and interviews, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on LIC 9099-D.

Regarding the allegation “Staff were unable to provide Paramedics with resident's records”, it was alleged that paramedics could not access the records of Resident #1 (R1) after they called 9-1-1. From interviews, staff do not recall the encounter with paramedics and R1. R1 claimed they had to communicate with paramedics and provide information since the facility was not able to. Based on interviews, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on LIC 9099-D.

Exit interview conducted. Copy of report provided. Appeal rights discussed.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (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
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20221202164248
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: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2023
Section Cited
CCR
87411(d)(3)
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87411 Personnel Requirements - General
(d) All personnel shall... have related experience in the job assigned to them. (3) Skill and knowledge required to provide necessary resident care... including the ability to communicate with residents.
This requirement is not met as evidenced by:
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Licensee has hired staff who can adequately communicate with residents. Deficiency is cleared as of 01/12/2023.
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Based on observations and interviews, the licensee did not comply with the section cited above in 2 out of 2 employees which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Type B
02/10/2023
Section Cited
CCR
87464(f)(3)
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87464 Basic Services (f) Basic services shall at a minimum include: (3) Three nutritionally well-balanced meals and snacks made available daily, including low salt or other modified diets
This requirement was not met as evidenced by:
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Licensee will conduct a training with all staff on food service requirements and submit to LPA by POC due date.
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Based on observations and interviews, the licensee did not comply with the section cited above in 3 out of 5 residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20221202164248
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: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2023
Section Cited
CCR
87506(c)(1)
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87506 Resident Records (c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent. This requirement is not met as evidenced by:
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Administrator showed LPA resident files which are ready for emergency responders. Staff have been trained. Licensee to submit written statement confirming that staff are capable of accessing emergency files for emergency personnel.
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Based on observations and interviews, the licensee did not comply with the section cited above in 1 out of 5 residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4