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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610162
Report Date: 08/08/2023
Date Signed: 08/08/2023 02:38:31 PM


Document Has Been Signed on 08/08/2023 02:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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
ADMINISTRATOR:PASCO, DINAH RFACILITY TYPE:
740
ADDRESS:17710 MARTHA STREETTELEPHONE:
(818) 585-0063
CITY:ENCINOSTATE: CAZIP CODE:
91316
CAPACITY:6CENSUS: 5DATE:
08/08/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Net & Ramon Barron - caregiversTIME COMPLETED:
02:30 PM
NARRATIVE
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On 8/82023, Licensing Program Analyst (LPA) arrived at the facility to conduct an initial complaint investigation, control #31-AS-20230801134042. This case management - deficiency report is to address deficiencies observed today.

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 (CHOW), and the Woodland Hills Regional Office has received no written notification that the facility is undergoing or plans to undergo a "CHOW". LPA explained this to David, and stated that due to that, he is currently the licensee/owner of this facility.

Additionally, during today's complaint visit, in relation to today's complaint investigation, LPA conducted records review from 12:00 - 12:30 p.m. and observed that no incident report was submitted to the Woodland Hills Regional Office for an incident on 7/25/23, where R1 wandered away from the facility and there whereabouts were confirmed by a local hospital about 1 week later.

Deficiencies issued per CA Code of Regulations, Title 22. Report signed and delivered. David designated staff to sign this report.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (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.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 08/08/2023 02:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 B
08/15/2023
Section Cited
HSC
1569.191(b)(2)

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ยง1569.191 Sale of licensed facility; resulting issuance of new license; procedure (b) Except as provided in subdivision (e), the property and business shall not be transferred until the buyer qualifies for a license or provisional license within the appropriate provisions of this chapter. (2) The prospective buyer shall submit an application for a license, as specified in Section 1569.15, within five days of the acceptance of the offer by the seller.

This requirement is not met as videnced by:
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The Licensee and the new applicant/buisness owner shall submit a Change of Ownership application by the POC due date. Furthermore, moving forward the licensee shall abide by HSC 1569.191, and document this on a written statement.
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Due to an interview with the Licensee, 2 staff, and records reviewed, the prospective buyer has failed to submit a Change of Ownership Application and the licensee has sold the business prior to the process defined in this regulations. This poses a potential health, safety or personal rights risk to residents in care.
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Type B
08/11/2023
Section Cited
CCR87211(a)(1)(D)

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87211Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.

This requirement is not met as evidenced by:
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The licensee and all staff shall particiate in vendorized training, pertaining to this regulation, for reporting requirements. Proof of training with materials and signatures shall by submitted by the POC due date.
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Based on interview and record review, the Licensee failed to submit an incident report to CCL or any other pertaining agencies regarding R1 wandering from the facility. This poses a potential/immediate health, safety or personal rights risk to residents in care.
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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 GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (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
LIC809 (FAS) - (06/04)
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