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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610429
Report Date: 12/19/2024
Date Signed: 12/20/2024 09:02:41 AM

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
12/16/2024 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20241216084841
FACILITY NAME:SIMPLE TOUCH BOARD AND CARE INCFACILITY NUMBER:
197610429
ADMINISTRATOR:SARKISYAN, KARINEFACILITY TYPE:
740
ADDRESS:22317 MOBILE STTELEPHONE:
(747) 444-8506
CITY:CANOGA PARKSTATE: CAZIP CODE:
91303
CAPACITY:6CENSUS: 3DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gegham Amirkhanyan, StaffTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility staff are unable to communicate with residents
INVESTIGATION FINDINGS:
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At 9:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced initial 10-day complaint investigation regarding the above allegation. LPA met with the staff, Gegham Amirkhanyan, who granted access to the facility. The staff contacted the Administrator and the LPA explained the reason for the visit. The Administrator was unable to come to the facility and designated the current staff to sign for the report.

During course of the investigation, interviews and record review were made. At 09:05am, LPA requested resident and staff roster. At approximately 09:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 09:20am – 10:30pm, LPA conducted an interview with the Administrator, one (1) staff, and three (3) residents.
Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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-20241216084841
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: SIMPLE TOUCH BOARD AND CARE INC
FACILITY NUMBER: 197610429
VISIT DATE: 12/19/2024
NARRATIVE
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Allegation: Facility staff are unable to communicate with residents

On 12/11/24, Licensing Program Analyst (LPA) Angela Panushkina and Regional Director, LTC Ombudsman Program, Ginger Perini conducted a complaint visit (control #31-AS-20241205141612 and #31-AS-20241209084739). During that visit, Staff #1 (S1) was working here and upon arrival the team attempted to communicate with S1 in English. The team observed that S1 did understand basic questions when asked in English, however S1 was unable to answer. S1 informed LPA that residents have used a translator app and written translations from Russian to English to be able to communicate. Moreover, residents interviewed did acknowledge that there is a language barrier, however they all agreed that for the most part they can get their point across. Interview with the Administrator confirmed that she is aware that S1 is not fluent in communicating in English and informed LPA that she’s always at the facility during the day and is able to assist with communication and at night, S1 can call her to assist with any translations. During today's visit, LPA was informed that as of 12/11/24, S1 no longer works here. Based on interviews and observation, the allegation is deemed SUBSTANTIATED.



Deficiency is cited on LIC 9099-D.
Exit interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20241216084841
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: SIMPLE TOUCH BOARD AND CARE INC
FACILITY NUMBER: 197610429
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2024
Section Cited
CCR
87411(d)(3)
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Personnel Requirements - General:
(d) All personnel shall... have related experience in the job assigned to them. (3) Skill and knowledge required to provide necessary resident care... including the ability to communicate with residents. This requirement is not met as evidenced by:
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LPA was informed that as of 12/11/24, S1 is no longer working at this facility. POC cleared during today's visit
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Based on observations and interviews, during 12/11/24 visit, the licensee did not comply with the section cited above to ensure that S1, is able to communicate with residents in English. This poses/posed a potential Health, Safety, or Personal Rights risk to persons 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.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3