197610054-7-5-2023-31-AS-NMAN-CW52ED-20230928171941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610054
Report Date: 07/05/2023
Date Signed: 07/05/2023 01:23:37 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
07/03/2023 and conducted by Evaluator Melissa Ruiz

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230703120422

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: 4	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:			TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Licensee does not ensure staff are able to communicate with residents in care.

INVESTIGATION FINDINGS:

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On 7/5/2023, Licensing Program Analyst arrived at the facility to conduct an initial 10-day complaint investigation.

Allegation: Licensee does not ensure staff are able to communicate with residents in care.

Upon LPAs arrival, LPA was greeted by staff (S1) and S1 was unable to thoroughly speak or communicate in English. S1 was the only staff at the facility during this visit, responsible for providing care and supervision to three out of four residents in care. Later on, another staff arrived at the facility (S2) who can communicate in English.

Based on LPAs observation and interviews, the allegation above is deemed SUBSTANTIATED. Deficiencies issued per CA Code of Regulations, Title 22. Report signed and delivered.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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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Control Number 31-AS-20230703120422

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: 07/05/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/12/2023 Section Cited CCR 87411(d)(3)	1 2 3 4 5 6 7	Personnel Requirements - General 87411(d)(3).. experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance.. Skill and knowledge required to provide necessary resident care and supervision,... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator/Licensee agrees to put in writing their plan for hiring or ensuring English Speaking staff are always on shift and submit the plan by the POC date. Additionally, Administrator shall submit updated LIC500 to reflect all staff.
	8 9 10 11 12 13 14	Based on LPA interview with staff, the administrator did not have staff available to communicate with residents and emergency personnel effectively which poses a potential risk to the residents 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: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

LIC9099 (FAS) - (06/04)

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