197610223-12-6-2022-31-AS-NGID-CLXPBJ-20221209101026

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610223
Report Date: 12/06/2022
Date Signed: 12/06/2022 11:13:32 AM

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
11/28/2022 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20221128113252

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: 3	DATE:	12/06/2022
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Rima Agaroyan/ Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff hit a resident while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above mentioned allegation. The LPA was greeted by facility staff and called the administrator. The administrator arrived a short while later.

The LPA was able to speak with all residents in care. 2 out of the 3 residents were verbal and were able to be interviewed. Residents interviewed denied ever being hit by a facility staff member or ever seeing another resident being hit by staff. The administrator was also interviewed and denied ever having a complaint from any resdident or family member regarding abuse. Staff interviewed also denied ever hitting any resident or ever seeing any other staff hit a resident.

Based on interviews with staff, residents and the administrator, this allegation is deemed unsubstantiated. Exit interview conducted and report issued.

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: 12/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022

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