197610223-8-19-2022-31-AS-NGID-CHKVJZ-20220823162933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610223
Report Date: 08/19/2022
Date Signed: 08/19/2022 12:00:05 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
08/12/2022 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20220812114502

FACILITY NAME:	NVM COMFORT HOMES		FACILITY NUMBER:	197610223
ADMINISTRATOR:	AGARONYAN, RIMA		FACILITY TYPE:	740
ADDRESS:	16473 MCKEEVER ST		TELEPHONE:	(818) 300-8393
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 4	DATE:	08/19/2022
		UNANNOUNCED	TIME BEGAN:	08:41 AM
MET WITH:	Rima Agaronyan/ Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility did not give resident a 30 day notice of rate change.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above mentioned allegation. The LPA was greeted by the facility staff and the facility administrator arrived about 20 minuets later. The LPA explained the reason for the visit.

The LPA was able to interview the facility staff and the administrator regarding this allegation. At 9:30 am, the administrator provided the LPA with a copy of the Residence and Services Agreement Short Term Respite/Guest Stay document. The document was signed and agreed to by the resident in question's (R1) responsible party. The document confirmed that R1 would stay at the facility between 7/20/22 and 7/30/22 for a reduced rate of $400 in total. After 7/30/22, the administrator informed the responsible party that the regularly daily rate of $150 would begin to accrue and eviction was discussed.

Continues on LIC 9099

Unsubstantiated

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: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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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Control Number 31-AS-20220812114502

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: NVM COMFORT HOMES	FACILITY NUMBER: 197610223
	VISIT DATE: 08/19/2022

NARRATIVE

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The LPA was able to speak with R1's responsible party at 10:10 am who informed the LPA that their case worker had agreed to assist in the payment and for the facility and to not to evict the resident. Copies of the invoice of these payments was provided to the LPA by the facility administrator. The responsible party confirmed that the they never intended to have R1 stay at the facility longer than the specified dates on the contract and understood that after the 7/30/22, the rates would return to the original price of $150 per day or $4,500 a month.

Based on interviews with the administrator, facility staff and R1's responsible party as well as a review of facility documentation, this allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted and report issued

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC9099 (FAS) - (06/04)

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