197610096-1-19-2023-31-AS-NGID-CNGQJM-20230127111255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610096
Report Date: 01/19/2023
Date Signed: 01/19/2023 01:52:09 PM

Unsubstantiated

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
12/16/2022 and conducted by Evaluator Melissa Ruiz

COMPLAINT CONTROL NUMBER: 31-AS-20221216093123

FACILITY NAME:	HEALTHY LIFE SERVICE FACILITY		FACILITY NUMBER:	197610096
ADMINISTRATOR:	TADEVOSYAN, LUSINE		FACILITY TYPE:	740
ADDRESS:	15921 LIGGETT STREET		TELEPHONE:	(818) 810-5955
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 3	DATE:	01/19/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Armine Dishoyan & Arusyak Ohanyan		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility overmedicating residents.
Facility does not offer planned activities.

INVESTIGATION FINDINGS:

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On 1/19/2023, Licensing Program Analyst (LPA) arrived at the facility to conduct an unannounced subsequent complaint visit. Upon arrival, LPA was greeted by the Administrator and Licensee. LPA conducted an entrance interview, and the purpose of the visit was explained.

It was alleged that the facility are overmedication residents.

To investigate this allegation, LPA collected documents relevant to this investigation, such as Centrally Stored Medication and Destruction Record (LIC622) for four (4) residents, and PRN (as needed) medication log for one (1) resident. On 12/20/2022, LPA conducted a random medication count of Lorazepam, a PRN medication filled on 7/19/22 for one (1) resident. Medication count and PRN log showed that as of 12/20/22’s visit, Lorazepam had been issued seven (7) times since the fill date. Additionally, LPA conducted interviews with three (3) out of five (5) residents who were able to communicate, and all residents deny being overmedicated or issued wrong medication.

Unsubstantiated

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: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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-20221216093123

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: HEALTHY LIFE SERVICE FACILITY	FACILITY NUMBER: 197610096
	VISIT DATE: 01/19/2023

NARRATIVE

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An interview with the Licensee, the Administrator, one (1) staff also revealed that there have been no known issues with any resident being over medicated. Based on record review, LPA observation, and interviews, the allegation mentioned above is Unsubstantiated at this time.

It was alleged that the facility does not offer planned activities.

To investigate this allegation, LPA conducted an interview with the Administrator. The Administrator stated that they do offer activities to the residents, however the residents in care enjoy their privacy and are not very active. The Administrator stated that for the most part, residents deny certain activities, but they do engage in conversations, games, and TV watching in the common rooms with staff. On 12/20/22, LPA conducted an interview with three (3) out of five (5) residents who were able to communicate, and they stated that they do not care much for games or activities. They enjoy watching TV, talking to family, and enjoy their privacy and for the most part, keep to themselves. Based on interviews conducted, the allegation mentioned above is Unsubstantiated at this time. During today's visit, LPA collected an activities list/schedule.

No deficiencies issued, this report was signed and delivered. Exit interview conducted.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

LIC9099 (FAS) - (06/04)

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