197610054-8-23-2023-31-AS-NRED-CUYNWL-20230823104944

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610054
Report Date: 08/23/2023
Date Signed: 08/23/2023 10:50:00 AM

Document Has Been Signed on 08/23/2023 10:50 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	LEO'S ASSISTED LIVING II		FACILITY NUMBER:	197610054
ADMINISTRATOR:	DANIELIAN, KHATCHIK		FACILITY TYPE:	740
ADDRESS:	7567 BOVEY AVENUE		TELEPHONE:	(310) 292-2992
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 2	DATE:	08/23/2023
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Khatchik Danielian		TIME COMPLETED:	10:50 AM

NARRATIVE

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A second Informal Conference was conducted today at the Woodland Hills-South Adult and Senior Care Regional Office. This Informal Conference was held to discuss the licensee’s abandonment of the facility and possible solutions to resolve the issue while accounting for the health and safety of the current residents.
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
- Levon Sayadayan
- Khatchik Danielian, Administrator
- Araksya Arzumanyan, caregiver
- Naira Margaryan, Licensing Program Manager (LPM)
- Nichelle Gillyard, 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. The Licensee has also operated Leo’s Assisted Living (197609916) since 03/05/2020.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEO'S ASSISTED LIVING II	FACILITY NUMBER: 197610054
	VISIT DATE: 08/23/2023

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Since then, the facility has accrued more deficiencies:

- 01/12/2023: LPA Reed completed multiple complaint investigations and issued Type B deficiencies under CCR 87307(a)(3)(A), 87411(c), 87411(d)(3), 87464(f)(3), 87506(c)(1), and 87555(b)(5).

- Liability Insurance and Licensee Abandonment:
· 05/31/2023 LPA Michael Cava contacted licensee Anna Gharibyan requesting proof of liability insurance. Licensee stated proof would be shown within 2 days.

· 06/27/2023 LPM Nichelle Gillyard contacted licensee Anna Gharibyan requesting proof of liability insurance once again, as it had not yet been provided.

· 07/05/2023 LPA Melissa Ruiz conducted a case management visit and issued a Type A deficiency under Health and Safety Code 1569.605 and a Type B deficiency under CCR 87411(d)(3) for staff being unable to communicate to residents in English.

· 07/27/2023 LPA Antonia Alvizar and LPM Naira Margaryan visited the facility and reissued the Type A deficiency under Health and Safety Code 1569.605.

· 08/04/2023 During an interview, Administrator Khatchik Danielian, facility staff Araksya Arzumanyan, and facility staff Narine Arakelyan stated licensee Anna Gharibyan has not been involved in facility affairs since selling the business in December 2021. The same information was verified by the Licensee Representative Levon Garibyan during phone conversation with LPM Margaryan on 08/15/2023.

Levon stated the previous liability insurance policy had expired and the licensee forgot to renew the policy. Anna stated that although Khatchik is the administrator, Anna is still the licensee but does not have much time to be at the facility in person. LPM Margaryan reiterated the chronic non-compliance and repeat violations must be addressed by the licensee to show her presence in the facility. Levon stated he owns the property and is leasing the property to Khatchik. LPM Gillyard explained the regulation for Licensee Accountability and stated that until the new application for Oasis II Assisted Living (197610389), the current licensee is still responsible for all facility operations and plans of corrections. LPM Margaryan discussed the possibility of a Non-Compliance Conference (NCC), Technical Support Program (TSP), and quarterly visits.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEO'S ASSISTED LIVING II	FACILITY NUMBER: 197610054
	VISIT DATE: 08/23/2023

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LPM Margaryan reviewed the outstanding deficiencies and plans of corrections which have not yet been cleared.

LPMs Gillyard and Margaryan stressed the importance of staff training to ensure person centered care is afforded, and the extensive hospice care requirements for each resident.

LPA Reed informed of the Regional Office email address for Plans of Corrections and hospice regulations. LPA Reed printed LIC 809-D pages with outstanding plans of corrections due, hospice regulations, and annual fee payment history.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC809 (FAS) - (06/04)

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