197610162-8-8-2023-31-AS-NMAN-CY7QMQ-20231204111755

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610162
Report Date: 08/08/2023
Date Signed: 08/08/2023 02:37:43 PM

Substantiated

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
08/01/2023 and conducted by Evaluator Melissa Ruiz

COMPLAINT CONTROL NUMBER: 31-AS-20230801134042

FACILITY NAME:	LOVE & CARE SENIOR LIVING, INC.		FACILITY NUMBER:	197610162
ADMINISTRATOR:	PASCO, DINAH R		FACILITY TYPE:	740
ADDRESS:	17710 MARTHA STREET		TELEPHONE:	(818) 585-0063
CITY:	ENCINO	STATE: CA	ZIP CODE:	91316
CAPACITY:	6	CENSUS: 5	DATE:	08/08/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Net & Ramon Barron - caregivers		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not provide resident adequate supervision resulting in resident leaving the facility unsupervised.

INVESTIGATION FINDINGS:

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On 8/82023, Licensing Program Analyst (LPA) arrived at the facility to conduct an initial complaint investigation. Upon arrival, LPA was met by two caregivers, staff #1 and staff #2 (S1) (S2). LPA explained the purpose of the visit, and an entrance interview was conducted. LPA was informed by the staff that the previous Administrator has resigned about a month ago. LPA spoke to the Licensee, David Hakobyan and stated the purpose of this visit. David stated that he has "sold the buisness" and the new owner is Paul Laus. LPA informed David that there is no Change of Ownership Application, therefore he is currently the licensee/owner of this facility. LPA requested their current Administrator to come to the facility, to which LPA was notified that she was not available. David designated staff to sign this report.

It was alleged that staff did not provide resident adequate supervision resulting in resident leaving the facility unsupervised. LPA conducted interviews with 2 out of 2 staff from 11:00 - 12:00 p.m. and 2 out of 2 staff stated that one resident, R1 left the facility through their bedroom window. S2 stated that the last time they saw R1 was at approximately 1:30 p.m. and S2 realized they escaped at approximately 3:00 p.m. Due to interviews conducted with 2 out of 2 staff, the allegation is deemed SUBSTANTIATED at this time.

Substantiated

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: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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-20230801134042

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: LOVE & CARE SENIOR LIVING, INC.	FACILITY NUMBER: 197610162
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/09/2023 Section Cited CCR 87705(b)(2)	1 2 3 4 5 6 7	87705 Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee is to generate a Resident Reappraisal for Resident #1 that addresses behaviors including but not limited to wandering from the facility without assistance and their care plan to reflect those behaviors.
	8 9 10 11 12 13 14	The licensee failed to indicate in R1's preplacement appraisal appraisal/needs and services plan a description of R-1's behavior of wandering. This poses an immediate health, safety or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC9099 (FAS) - (06/04)

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