197610441-2-6-2024-31-AS-NGID-D2HREU-20240216115803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610441
Report Date: 12/12/2023
Date Signed: 02/06/2024 03:44:45 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
11/14/2023 and conducted by Evaluator Leslie Ngo-Castaneda

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20231114120121

FACILITY NAME:	A NEW LIFE BOARD AND CARE		FACILITY NUMBER:	197610441
ADMINISTRATOR:	KARAPETYAN, GURGEN		FACILITY TYPE:	740
ADDRESS:	19435 STRATHERN ST		TELEPHONE:	(747) 237-2337
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 4	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Amy Pancho- Staff		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Resident fell due to neglect.
Staff did not ensure that resident's incontinence needs were met.

INVESTIGATION FINDINGS:

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This is an Amendment to the original report issued 01-29-2024 to clarify the findings.

During today's visit 12-12-2023, before delivering the final report, LPA conducted a physical plant tour, to ensure the health and safety of the residents are protected and physical plant follows Title 22 Regulations.

It was alleged that R1 fell due to neglect.

The complainant’s concern is that on 06-29-2023 Resident #1(R1) was found lying on the floor and believes the resident fell.

To investigate this allegation, LPA conducted an interview with staff, and residents. A records review was conducted.
LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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-20231114120121

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: A NEW LIFE BOARD AND CARE	FACILITY NUMBER: 197610441
	VISIT DATE: 12/12/2023

NARRATIVE

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LPA requested and obtained Calls for Service with the local Emergency Service Agency during the time R1 was admitted. Upon review of the Calls for Service documents, there was no indication that R1 had fallen. R1 was having a medical incident during mealtime at the dining table, to prevent a fall, staff laid R1 on the floor. R1 did not fall, then 911 was called. It was founded that R1 had expired from natural causes. LPA was also able to interview the hospice nurse and obtain hospice records, there was no indication that R1 had fallen in the facility while in care. LPA obtained death certificate and it was indicated cause of death is ‘cardiorespiratory failure and hypertensive heart disease’. There was no evidence of a fall that contributed to the death on the Death Certificate. Administrator and two (2) staff all denied the allegation and reported that R1 never fell, allegation is false. Interview with residents stated that they had never witness any of the resident at the facility fall, residents stated that they always gets assistance from staff to be move around the facility.

Based on inspection and interviews there is not sufficient evidence to support the allegation. Therefore, the allegation is unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.

It was alleged that R1 fell due to staff neglect and staff did not ensure the residents incontinence R1 were met.

Upon interview of two (2) out of four (4) residents, they are happy and content with the facility, no complaints so far. An attempt interview was done for the other two (2) of the residents but was unavailable. LPA interviewed hospice nurse and was advised that the facility has always ensured the health and safety of the residents. LPA interviewed two (2) staff, licensee and administrator about the care given to the residents and stated that incontinence is changed every 2-3 hours or when residents soiled themselves. Hospice nurse witness that when residents asked for help, staff immediately attends to their needs. Administrator and two (2) staff all denied the allegation and reported that R1 incontinence care is false.

Based on inspection and interviews there is no sufficient evidence to support the allegation. Therefore, the allegation is unsubstantiated at this time.
No Deficiency cited during today's visit. Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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