197610123-12-12-2022-31-AS-NGID-CMCQRJ-20221222112401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610123
Report Date: 12/12/2022
Date Signed: 12/12/2022 01:38:07 PM

Unfounded

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
12/01/2022 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20221201164003

FACILITY NAME:	CONCORDIA ASSISTED LIVING		FACILITY NUMBER:	197610123
ADMINISTRATOR:	YEGEYAN, NAZAR		FACILITY TYPE:	740
ADDRESS:	16704 BLACKHAWK STREET		TELEPHONE:	(818) 403-1803
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	12/12/2022
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Nazar Yegeyan		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility staff physically abused residents.
Facility staff did not assist resident who was being threatened by another resident.
Facility staff did not ensure that timely medical care was provided for residents.
Facility staff did not ensure that residents were regularly observed for changes in functioning.
Resident not accorded dignity in relationships with facility staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patrick Shanahan, arrived at the facility in response to the above mentioned allegations. The LPA was greeted by the facility administrator and was able to review a list of the residents living at the home. After the LPA was able to review resident files and interview the facility administrator it became clear that the resident in question had never lived at this location.

Based on interviews conducted and a review of resident files, this allegation is deemed UNFOUNDED.

A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.

Exit Interview conducted and report issued.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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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