<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610111
Report Date: 05/05/2023
Date Signed: 05/05/2023 02:58:39 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
04/27/2023 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20230427151459
FACILITY NAME:CALIFORNIA STATE HEALTH GROUP LLCFACILITY NUMBER:
197610111
ADMINISTRATOR:ANDRANIK KAPIKYANFACILITY TYPE:
740
ADDRESS:9526 SALOMA AVETELEPHONE:
(818) 660-7742
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 6DATE:
05/05/2023
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Adranik Kapikyan, Liana GafikyanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff prevented resident from making/receiving phone calls
Staff prevented resident from socializing with other residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts Gary Tan and Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPAs met with the administrator, Adranik Kapiyan, and staff, Liana Gafikyan, and advised them of the complaint. Today's investigation consisted of interviews with the administrator, staff and residents. A physical plant inspection to insure the health and safety of the residents in care was conducted and record reviews were made. Also, during the course of the investigation, LPAs made a collateral visit to another facility, to conduct interviews with additional residents.

Staff prevented resident from making/receiving phone calls:
In regards to the allegation, it was reported that residents were not allowed to make phone calls or get in touch with family. LPAs were able to interview four (4) out of the six (6) residents, who deny the allegation. One resident was non verbal, and did not respond to LPAs questions. Another resident declined to interview.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
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 3
Control Number 31-AS-20230427151459
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: CALIFORNIA STATE HEALTH GROUP LLC
FACILITY NUMBER: 197610111
VISIT DATE: 05/05/2023
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
Based on the information obtained, there was insufficient evidence to prove residents are being prevented to make and receive calls. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff prevented resident from socializing with other residents in care:
In regards to the allegation, it was reported that staff wouldn’t let residents "mingle" or talk to the other residents. LPAs were able to interview four (4) out of the six (6) residents, who deny the allegation. One resident was non verbal, and did not respond to LPAs questions. Another resident declined to interview. Based on the information obtained, there was insufficient evidence to prove that staff prevent residents from socializing. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
04/27/2023 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20230427151459

FACILITY NAME:CALIFORNIA STATE HEALTH GROUP LLCFACILITY NUMBER:
197610111
ADMINISTRATOR:ANDRANIK KAPIKYANFACILITY TYPE:
740
ADDRESS:9526 SALOMA AVETELEPHONE:
(818) 660-7742
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 6DATE:
05/05/2023
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Adranik Kapikyan, Liana GafikyanTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent resident from injuring another resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts Gary Tan and Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPAs met with the administrator, Adranik Kapiyan, and staff, Liana Gafikyan, and advised them of the complaint. Today's investigation consisted of interviews with the administrator, staff and residents. A physical plant inspection to insure the health and safety of the residents in care was conducted and record reviews were made. Also, during the course of the investigation, LPAs made a collateral visit to another facility, to conduct interviews with additional residents.

In regards to the above allegation, it was reported that approximately Resident 1 (R1) was attacked by Resident 2 (R2). Interview made with R1 confirms that this incident did not occur at California State Health Group, but at another facility. This agency has investigated the complaint and has determined that the above allegation is deemed unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3