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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610054
Report Date: 10/27/2022
Date Signed: 10/27/2022 04:49:42 PM


Document Has Been Signed on 10/27/2022 04:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 IIFACILITY NUMBER:
197610054
ADMINISTRATOR:ARAKELIAN, ARMINEFACILITY TYPE:
740
ADDRESS:7567 BOVEY AVENUETELEPHONE:
(310) 292-2992
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: DATE:
10/27/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Sofia HernandezTIME COMPLETED:
05:00 PM
NARRATIVE
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At 4:00 p.m. on 10/27/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an announced case management visit to address deficiencies. LPA met with staff and disclosed the reason for the visit.

LPA notified the Administrator of the meeting on 10/26/2022 at 11:13 a.m. LPA called the Administrator on 10/27/2022 at 2:27 p.m. and 3:20 p.m. and left voicemails.

At 4:15 p.m. LPA requested to review facility personnel records. The records were not available for audit.

LPA observed S1 and S2 working at the facility during the visit.

During today's inspection, the facility is not in compliance with Title 22 regulations.

For failure to submit plan of corrections, a civil penalty in the amount of $2,100.00 ($100 per day X 21 days) is hereby assessed on 10/27/2022. Civil penalties are ongoing in the amount of $100 per day, per employee until the deficiency is cleared.



Exit interview conducted. Copy of report, appeal rights, and citations issued.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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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Document Has Been Signed on 10/27/2022 04:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 10/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2022
Section Cited

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87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator...The administrator shall be on the premises a sufficient number of hours to permit adequate attention to the management ... of the facility.
This requirement is not met as evidenced by:
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Based on observations the licensee did not comply with the section cited above in 1 administrator which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Type B
11/25/2022
Section Cited

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87412 Personnel Records (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
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Based on observations the licensee did not comply with the section cited above for 2 out of 8 employees 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: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
LIC809 (FAS) - (06/04)
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