197610382-4-25-2023-31-AS-MVAO-CYPNLA-20231220093309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610382
Report Date: 04/25/2023
Date Signed: 04/25/2023 02:14:14 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
04/21/2023 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20230421132240

FACILITY NAME:	LIFELONG SENIOR LIVING		FACILITY NUMBER:	197610382
ADMINISTRATOR:	KAPIKYAN, ANDRANIK		FACILITY TYPE:	740
ADDRESS:	16003 LUDLOW STREET		TELEPHONE:	(747) 203-4493
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	04/25/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Adranik Kapikyan		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Unlicensed care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Michael Cava and Gary Tan conducted a complaint visit to the facility to investigate the above allegation. LPA's met with the Licensee Representative Adranik Kapikyan and advised him of the complaint. The facility has a pending application with the Central Applicaions Bureau (CAB), and although a Pre-Licensing inspection was made on 04/06/23, the Department received a complaint alleging that the applicant is providing care and supervision to at least four (4) residents. These residents have been living at the home, since at least January 2023. On the day of the Pre-Licensing inspection, these residents were taken on an outing for approximately five hours, in order to falsify and portray to the Licensing Agency that the home is not occupied by any residents.

Today's investigation consisted of a physical plant inspection to insure there are no immediate health and safety risks to the residents and care. LPAs also interviewed five (5) out of six (6) residents. Based on these interviews, LPAs identified that two (2) out of the six (6) residents require elements of care and supervision.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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

Control Number 31-AS-20230421132240

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: LIFELONG SENIOR LIVING	FACILITY NUMBER: 197610382
	VISIT DATE: 04/25/2023

NARRATIVE

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Therefore, based on the information received during this investigation, the allegation of Unlicensed care is Substantiated. Pursuant to Health & Safety code, a citation and Notice of Violation of Law (NOVL) will be issued. The Licensee/Representative was advised to cease operation. They were also advised that continued operation, pending the process of their application is a violation of law, subject to civil penalties and could result in civil and/or criminal action being taken against them.

A copy of this report issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230421132240

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: LIFELONG SENIOR LIVING	FACILITY NUMBER: 197610382
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/25/2023 Section Cited HSC 1569.10	1 2 3 4 5 6 7	RCFE; license or permit; necessity: No person, firm, partnership, association, or corporation within the state and no state or local public agency shall operate, establish, manage, conduct, or maintain a residential facility for the elderly in this state without a current valid license or current valid	1 2 3 4 5 6 7	As POC, the licensee representative agrees to cease operation. They were also advised that continued operation, pending the process of their application is a violation of law, subject to civil penalties and could result in civil and/or criminal action being taken against them.
	8 9 10 11 12 13 14	special permit therefor, as provided in this chapter. This requirement has not been met as evidenced by interviews made with two (2) residents, who have admitted they require care & supervision. This poses an immediate health and safetyl 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: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3