197610111-4-12-2024-31-AS-MVAO-D49PBM-20240412111035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610111
Report Date: 03/20/2024
Date Signed: 04/12/2024 08:59:22 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
02/13/2023 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20230213141642

FACILITY NAME:	CALIFORNIA STATE HEALTH GROUP LLC		FACILITY NUMBER:	197610111
ADMINISTRATOR:	SIMITYAN, ARMENUI		FACILITY TYPE:	740
ADDRESS:	9526 SALOMA AVE		TELEPHONE:	(818) 660-7742
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY:	6	CENSUS: 6	DATE:	03/20/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Nataly Canales- Staff		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff handled resident roughly.
Staff did not change resident timely.
Staff did not shower resident timely
Staff did not provide resident privacy
Staff spoke to resident inappropriately
Staff did not provide resident's food of nutritious quality to meet resident's needs.

INVESTIGATION FINDINGS:

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This is an amended report due to clerical error. On 02.17.2023 LPA Angela Panushkina was the one who initiated the investigation for the complaint not Melissa Ruiz.
On 03.20.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced subsequent visit to deliver the determination on the above allegations. LPA was greeted by Isiah Phiri (S2) who granted access. S2 contacted the administrator Andranik Kapikyan (S1) to advise that LPA was at the facility. The administrator arrived at 2 PM, and LPA explained the purpose of the visit.
At 12:25 PM LPA conducted a physical plant tour to ensure the health and safety of the residents in care.
Allegation: Staff handled resident roughly

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted a subsequent complaint visit. Regarding the allegation above it is alleged that facility staff handled resident R1 roughly. On 02.17.2023 LPA Melissa Ruiz initiated this investigation for the complaint.
Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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 4

Control Number 31-AS-20230213141642

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CALIFORNIA STATE HEALTH GROUP LLC	FACILITY NUMBER: 197610111
	VISIT DATE: 03/20/2024

NARRATIVE

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Regarding the allegation “Staff handled residents in care in a rough manner” it was alleged staff have aggressively grabbed and pulled R1. According to R1, there was no bruising, staff grabbed R1's wrist roughly. LPA interviewed staff and residents on 03.20.2024 from 1:30 PM to 2:15 PM. Five (5) out of six (6) residents interviewed stated they had never experienced or witnessed staff handling residents roughly. Residents interviewed had no concerns about staff handling residents roughly or inappropriately. LPA interviewed the administrator and two (2) out of two (2) staff stated they do not handle residents roughly nor have they seen staff handling residents roughly. Staff interviewed stated they have not handled residents roughly nor heard of any other staff handling residents roughly.

Based on interviews, residents were not handled rough manner by staff. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation: Staff did not change resident timely
It was alleged that R1's diaper would be soiled and soaked, and R1 needed to yell and wait for staff to change their diaper. Interviews with the administrator and two (2) staff revealed that all residents are checked or changed at least every three (3) hours or as needed. Moreover, LPA was informed that five (5) out of six (6) residents when they ask for help with toileting needs the staff immediately would assist. LPA was able to interview five (5) out of six (6) residents regarding this allegation. Residents interviewed confirmed that they are assisted to be taken to the restroom whenever they request which has not been a concern.

Based on interviews, this allegation is deemed UNSUBSTANTIATED at this time.

Allegation: Staff did not shower resident timely

It was alleged that R1 would receive showers only once or twice a week and wanted more when needed. R1 stated that staff would ignore and refuse R1's requests for shower. To investigate the allegation LPA Leslie Ngo-Castaneda interviewed the administrator and two (2) staff out of two (2) staff and five (5) out of six (6) residents. Residents reveal that they are happy with staff help with shower care. Residents reveal that they never have any issues with showering. Hospice nurses help with R2 and R3 with showers. Staff interviews reveal that staff assist promptly and are fully staffed to assist residents with showers.
Continue to LIC 9099-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20230213141642

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CALIFORNIA STATE HEALTH GROUP LLC	FACILITY NUMBER: 197610111
	VISIT DATE: 03/20/2024

NARRATIVE

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Document review revealed that R2 and R3 do need assistance with the shower and received it as scheduled. Based on observation, interviews, and document review there is insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Allegation: Staff did not provide resident privacy

It was alleged staff did not respect the client's privacy. Staff would just barge into their room without knocking or leave their room ajar so that staff could eavesdrop on their conversation. During today's visit, from 11:30 AM to 2:15 PM. LPA conducted a physical plant inspection and interviewed the administrator, (2) staff, and five (5) out of (6) clients. Based on interviews, clients reported to LPA that staff knock on the door before they enter, and their privacy is respected. Although it was reported that some of the clients do not answer their door when staff call them or leave their bedroom door open, staff still knock on their door before they enter, based on interviews, the allegation is UNSUBSTANTIATED at this time.

Allegation: Staff spoke to resident inappropriately

In regards to the allegation, it was alleged that while R1 is wheelchair bound, staff would approach R1 and aggressively yell or curse out R1. There were no witnesses or suspects identified to the allegation. Nor was there a date and time given. Interviews with the administrator and two (2) staff deny such allegations had occurred since their employment. LPA interviewed five (5) out of (6) residents that they were happy and satisfied with the facility and care from staff. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff speaking inappropriately to R1.

Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Allegation: Staff did not provide resident's food of nutritious quality to meet resident's needs

Regarding the allegation that the food is not nutritious enough to meet the needs of residents, it was alleged that the facility is only serving "junk food". LPA observation today revealed that the facility's lunch today consists of salad and hamburger. For breakfast, residents and staff advised LPA that hot cereal was served. LPA observation also revealed that today, they have an alternate menu in case a resident does not like what they are serving for lunch today.
Continue to LIC 9099-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 31-AS-20230213141642

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CALIFORNIA STATE HEALTH GROUP LLC	FACILITY NUMBER: 197610111
	VISIT DATE: 03/20/2024

NARRATIVE

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LPA interview with five (5) out of six (6) residents today between 11:30 AM to 2:15 PM revealed that five (5) out of six (6) residents like the food served today and likes the food at the facility in general. All five (5) residents also stated that the food served was nutritious enough for them.

Based on the information gathered during this visit, the above allegations are deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4