197610054-7-10-2023-31-AS-NMAN-CW52EC-20230928171941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610054
Report Date: 07/10/2023
Date Signed: 07/10/2023 04:13:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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 Antonia Alvizar

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:	07/10/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Khatchik Danielian, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure facility is free of insects for residents in care
Staff do not ensure bathing assistance is provided to residents
Staff do not ensure resident is accorded clean bed linens

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Manager Licensing Program Analyst (LPA) Antonia Alvizar conducted a subsequent visit to the facility to complete investigation initiated on 07/05/2023 by LPA Melissa Ruiz. Upon arrival LPA was greeted by staff (S1) and S1 granted LPA entrance. S1 contacted Administrator, Khatchik Danielian via phone and explained the purpose of this visit. At 10:50AM a Khatchik arrived and assisted during this visit.
LPA conducted physical plant tour at 10:55AM, requested copies of facility documents relevant to the investigations. Between 11:45AM to 1:50PM interviewed two (2) staff and four (04) out of four (04) residents. At 2:15PM LPA received Emergency information, Physician Report, Resident Appraisal, Shower Schedule, Needs and Service Plan.

Staff do not ensure facility is free of insects for residents in care
It is alleged that resident had several bug bites on body but did not know what type of bites they were from. During physical plant tour LPA Alvizar inspected residents’ rooms and did not observe any signs of insects in faciltity and/or residents' bed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

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 2

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
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: 07/10/2023

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

Staff interviews revealed that facility is free of insects, and they have not seen any insects in the facility. Four (4) out of four (4) residents stated that they have not experience any bug bites and facility does not have any bugs.

Based on observation and interviews, there is an insufficient information to support the allegations. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff do not ensure bathing assistance is provided to residents

It is alleged that resident has not been bathed in two (2) weeks due staff not showing up. Staff interviews revealed that resident are given showers as schedule however some resident refuse to shower because they feel sick. Four (4) out of four (4) residents stated that they receive showers and/or bed baths from facility staff and/or outside services as schedule.

Based on observation, interviews, and record review there is an insufficient information to support the allegations. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff do not ensure resident is accorded clean bed linens

It is alleged that the residents bed sheets are not washed on a regular basis and are dirty. During physical plant tour LPA Alvizar inspected laundry room, residents’ rooms and did not observe any dirty bed linens. Staff interviews revealed that dirty bed linens are cleaned daily. Four (4) out of four (4) residents stated that the facility keeps the bed linens clean and the washer machine is always operating cleaning all dirty linens and clothing.

Based on observation and interviews, there is an insufficient information to support the allegations. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2