197610269-6-11-2024-31-AS-NMAN-D93RF8-20240913125842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610269
Report Date: 06/11/2024
Date Signed: 06/11/2024 05:19:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
06/05/2024 and conducted by Evaluator Leizl De La Cerra

COMPLAINT CONTROL NUMBER: 31-AS-20240605130632

FACILITY NAME:	HOUSE OF HOPE ASSISTED LIVING, INC		FACILITY NUMBER:	197610269
ADMINISTRATOR:	ALABERKYAN, GAYANE		FACILITY TYPE:	740
ADDRESS:	9617 STANWIN AVENUE		TELEPHONE:	(818) 302-6344
CITY:	ARLETA	STATE: CA	ZIP CODE:	91331
CAPACITY:	6	CENSUS: 4	DATE:	06/11/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Oleg Markiv		TIME COMPLETED:	05:18 PM

ALLEGATION(S):

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Staff does not ensure resident is accommodated with requested bed.

INVESTIGATION FINDINGS:

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On 06/11/24, Licensing Program Analyst (LPA) Leizl de la Cerra made an unannounced visit to this facility to investigate a complaint. LPA identified herself at the door when greeted by the male staff who identified himself as a caregiver for the facility and provided his name. LPA was granted access and explained the reason for the visit. The administrator was not available and S1 proceeded to call the administrator by phone.
It was alleged that resident #1 (R1) has been requesting for a new bed with bed rails since May 21st, 2024 and did facility did not accommodate R1.
At the time of this visit at (time) LPA requested S1 to provide facility records included but not limited to the residents and staff roster and resident’s files. S1 was unable to provide requested records and stated that he has no knowledge of where any of the records were.
At 10:25am LPA conducted a facility tour. During facility inspection, LPA observed a total of (4) four residents in care of the facility.
CONTINUED to LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La Cerra	TELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

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-20240605130632

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: HOUSE OF HOPE ASSISTED LIVING, INC	FACILITY NUMBER: 197610269
	VISIT DATE: 06/11/2024

NARRATIVE

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To investigate the allegation at 10:38a, LPA interviewed resident (R1) at 11:00am, LPA spoke with the facility staff and at (time) LPA discussed the allegation with the Administrator over the phone.
LPA DeLACerra observed and assessed R1 during interview. R1 is an amputee (Left foot amputated) and is in hospice care. R1 was already using hospital bed. L PA observed that the bed for R1 was in good repair.
R1 revealed that they are residing in the facility since May 21, 2024. R1 was placed in bedroom #2 with a hospital bed. Resident verified that currently they are receiving hospice services. On 05/22/2024, R1 was given a suggestion by the hospice worker to request a new hospital bed with bedrails. Within the same day, R1 followed the suggestion, and requested from a facility staff #2 (S2) who is administrator’s designee, a new hospital bed with bed rails. R1 verified that they had no prescription for a new hospital bed or bed rails issued for him by a physician. R1 also stated that the bed rails would help him for mobility due to being an amputee. The staff indicated that R1’s request was revealed to the hospice agency. Since R1 already had hospital bed, they ordered half bed rail for R1’s mobility.
During the course of investigation while interviewing R1, a delivery person came from AAA Healthcare Products, Inc. and delivered the half bed rails for R1 in R1’s room. Staff revealed that R1’s request was discussed with the hospice agency. Bed rails were ordered on 06/07/2024 and delivered today on 06/11/2024. LPA visibly witnessed the delivery of the bed rails.
Based on observation, interview and record reviews, there was not enough supporting information to confirm the allegation. Therefore, the allegation deemed unsubstantiated at this time.
During this investigation, LPA noted other Title 22 Deficiencies. Therefore, Case Management visit was conducted to address other deficiencies unrelated to the complaint.
Exit interview was conducted. Copy of report was signed by the facility staff. Due to the Administrator not being present at the facility, the copy of report will be delivered to the Administrator via e-mail.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La Cerra	TELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC9099 (FAS) - (06/04)

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