197610054-7-27-2023-31-AS-NMAN-CWKS2N-20231013132949

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610054
Report Date: 07/27/2023
Date Signed: 07/27/2023 04:59:30 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
07/24/2023 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230724090132

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: 3	DATE:	07/27/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Sona Gevorkyan, designee		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff is not being rotated and repositioned resident resulting in multiple pressure injuries
Staff are not maintaining a comfortable room temperature for residents

INVESTIGATION FINDINGS:

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Licensing Program Manager (LPM) Nichelle Gillyard and Licensing Program Analyst (LPA) Antonia Alvizar conducted a complaint investigation visit to the facility. Upon arrival LPM and LPA was greeted by staff and granted LPM and LPA entrance. Staff contacted Designee Administrator, Sona Gevorkyan via phone and explained the purpose of this visit. At 10:07AM a few minutes later Sona assisted during this visit.
Entranance interview conducted.

LPM and LPA conducted physical plant tour at 10:15AM, requested copies of facility documents relevant to the investigations. At 10:45 AM LPM and LPA conducted file review. Between 11:37AM to 1:54PM interviewed three (3) staff and three (3) residents. At 3:26PM LPM obtained photos of R1’s file which include the following documents: Emergency information, Physician Report, Resident Appraisal, Hospice Records, Needs and Service Plan.

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: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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-20230724090132

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: 07/27/2023

NARRATIVE

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Allegation: Staff is not rotating and repositioning resident resulting in multiple pressure injuries

During interview R1 indicated that they are able to reposition every two (2) hours and is non-ambulatory per physician report dated 03-14-2023. R1 can communicate and ask for help when needed. R1 indicated that there is no problem with the care being provided at the facility. Staff interviews confirmed that R1 was rotating as needed and staff assisted R1 by placing pillows in areas to relieve pressure points. Interviews were conducted with Hospice agency who indicated that staff are educated on the care associate with the resident’s wounds.

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

Allegation: Staff are not maintaining a comfortable room temperature for residents.

The complainant concern is that the air conditioner was not on during a visit. At 10:15AM LPA/LPM conducted a tour of the facility and observed that the air conditioner was on and operational, and the temperature measured at 85 degrees Fahrenheit. The temperature fell within regulation. LPA also observed fans in rooms for additional cooling. Two out of 3 staff indicate there were no complaints of excessive heat and that the air conditioner was ever turned off. Three (3) out of three (3) residents interviewed stated that sometimes is a little warm but if they ask staff to turn on the Air Conditioner higher, they do.

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: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

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