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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610441
Report Date: 06/12/2024
Date Signed: 06/12/2024 02:45:44 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
06/04/2024 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20240604095416
FACILITY NAME:A NEW LIFE BOARD AND CAREFACILITY NUMBER:
197610441
ADMINISTRATOR:KARAPETYAN, GURGENFACILITY TYPE:
740
ADDRESS:19435 STRATHERN STTELEPHONE:
(747) 237-2337
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 5DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gurgen Karapetyan, Administrator TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility is using kitchen equipment in poor repair.
Facility staff/or Administrator is recording private conversations.
INVESTIGATION FINDINGS:
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At 9:00am, Licensing Program Analyst (LPA) Angela Panushkina and Licensing Program Manager (LPM) Nichelle Gillyard conducted an unannounced complaint visit. LPA and LPM met with Gurgen Karapetyan, Administrator and discussed the reason for the visit.

During course of the investigation, interviews and record review were made. At 9:05am, LPA and LPM requested resident and staff roster. At 9:10am, LPA and LPM requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Staff Training, relevant to the investigation. At approximately 9:15am, LPA and LPM 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 10:00am – 11:00am, LPA and LPM interviewed the Administrator, two (2) staff, and three (3) residents out of five (5) residents who were able to communicate.

Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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 6
Control Number 31-AS-20240604095416
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: A NEW LIFE BOARD AND CARE
FACILITY NUMBER: 197610441
VISIT DATE: 06/12/2024
NARRATIVE
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Allegation: Facility is using kitchen equipment in poor repair.

It was alleged that the facility is using a burned-out microwave to heat food, and this is health hazard. To investigate this allegation LPM and LPA tested the microwave in the kitchen and observed it is operational. However, it was also observed that the inside coating is rusted and chipping away. LPM and LPA conducted a web review regarding the issue and per products.geappliances.com states that if the coating is flaking or peeling to discontinue the use of the microwave and replace it. Based on the information gathered and observation, this allegation is Substantiated at this time.

Allegation: Facility staff/ or administrator is recording private conversations.

It was alleged that the facility has cameras and are recording conversations. To investigate this allegation, LPM and LPA conducted an interview with the Administrator and the Designee and both confirmed that the facility has video surveillance equipment that is capturing audio conversation. This is a personal rights violation. LPM and LPA also requested to provide a footage of a current audio recording and confirmed the above allegation. Based on an observation and information gathered this allegation is deemed Substantiated at this time.

Deficiencies issued per Title 22.

Exit interview conducted appeal rights explained and copy of this report provided to the Administrator.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
06/04/2024 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20240604095416

FACILITY NAME:A NEW LIFE BOARD AND CAREFACILITY NUMBER:
197610441
ADMINISTRATOR:KARAPETYAN, GURGENFACILITY TYPE:
740
ADDRESS:19435 STRATHERN STTELEPHONE:
(747) 237-2337
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 5DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gurgen Karapetyan, Administrator TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Staff not following medications procedures.
Staff not providing hygiene products.
Insufficient staffing.
Facility screens in poor repair.
Administrator's certificate expired.
INVESTIGATION FINDINGS:
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At 9:00am, Licensing Program Analyst (LPA) Angela Panushkina and Licensing Program Manager (LPM) Nichelle Gillyard conducted an unannounced complaint visit. LPA and LPM met with Gurgen Karapetyan, Administrator and discussed the reason for the visit.

During course of the investigation, interviews and record review were made. At 9:05am, LPA and LPM requested resident and staff roster. At 9:10am, LPA and LPM requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Staff Training, relevant to the investigation. At approximately 9:15am, LPA and LPM 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 10:00am – 11:00am, LPA and LPM interviewed the Administrator, two (2) staff, and three (3) residents out of five (5) residents who were able to communicate.

Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 31-AS-20240604095416
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: A NEW LIFE BOARD AND CARE
FACILITY NUMBER: 197610441
VISIT DATE: 06/12/2024
NARRATIVE
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Allegation: Staff not following medications procedures.

It was alleged that the facility staff are touching medications with their hands. To investigate this allegation, LPM and LPA conducted an interview with the S1 and S2 and were informed that before pouring the medications in residents cups, they wear gloves and never touch the pill. S1 also informed LPM and LPA that all staff have taken medication training and are well aware on how to handle residents’ medication. Moreover, LPM and LPA requested S1 to demonstrate how the medications are being dispensed and observed that staff properly following medications procedures. LPA also reviewed and collected S1's and S2's current medication training. Based on interviews and observation this allegation is deemed Unsubstantiated at this time.

Allegation: Staff not providing hygiene products.

It was alleged that R1’s family member had to provide gloves and diapers for R1 while in care. To investigate this allegation, LPM and LPA conducted review of R1’s Admission Agreement and observed that on page 3, R1/family declined optional services to be provided by the facility, which means that R1/family will purchase/provide hygiene products upon request. Interview with the Administrator confirmed that R1’s family agreed to provide gloves and diapers upon request. However, per staff interview, should R1 run out of incontinent supplies, the facility maintains a supply and will provide r=to R1 and any other resident in need. Moreover, it was alleged that the bathrooms had no toilet papers or paper towels. During the walk through LPM and LPA observed two (2) out of two (2) bathrooms fully stocked with toilet paper and paper towels. Based on observation and information gathered, this allegation is deemed Unsubstantiated at this time.

Allegation: Insufficient staffing.

To investigate this allegation, LPM and LPA requested LIC500 (Personnel Report) and observed that the facility had seven (7) staff members registered to work. Interview with the Administrator revealed that the facility has enough staff to cover for each shift and all individuals listed on LIC500 are associated to this facility and still currently scheduled to work at the facility. Moreover, LPM and LPA conducted interviews with three (3) residents and all residents interviewed expressed no concerns regarding this allegation. Upon arrival LPM and LPA observed two (2) staff on duty, meeting residents needs. Therefore, based on interviews and record reviews this allegation is deemed Unsubstantiated at this time.

Continue on LIC9099-C

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 31-AS-20240604095416
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: A NEW LIFE BOARD AND CARE
FACILITY NUMBER: 197610441
VISIT DATE: 06/12/2024
NARRATIVE
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Allegation: Facility screens in poor repair.

It was alleged that the window screen are in poor repair. To investigate this allegation, at 09:00am LPM and LPA conducted a physical plant tour of the entire facility: four (4) bedrooms, living room, dining room and two (2) bathrooms and checked all window screens. LPM and LPA observed that all window screens were properly installed and in good repair. Based on LPMs’ and LPAs’ observation this allegation is deemed Unsubstantiated at this time

Allegation: Administrator's certificate expired.

To investigate this allegation, at 11:00am, LPA conducted review of “Active Certification List” (updated on 06/05/24) and observed that the Administrator, Gurgen Karapetyan, received his most recent certificate effective 03/09/23 and will be expiring on 03/08/25. The facility designee/Administrator backup, Diana Karapetyan’s certificate expired on March 5th, 2024 and the renewal was submitted in January 2024, however, the actual certificate is still pending. Based on record review this allegation is deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 31-AS-20240604095416
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: A NEW LIFE BOARD AND CARE
FACILITY NUMBER: 197610441
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2024
Section Cited
CCR
87555(b)(29)
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General Food Service Requirements: (b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips.
This requirement is not met as evidenced by:
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Administrator agreed to replace the microwave and a copy of the reciept will be submitted to LPA
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Based on LPA and LPM's observation, licensee did not comply with the section cited above by having/using a microwave that has the inside coating rusted and chipping away. This poses a potential health and safety risk to residents in care.
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Type B
06/19/2024
Section Cited
CCR
87468.2(1)
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Additional Personal Rights of Residents in Privately Operated Facilities: (1) To have a reasonable level of personal privacy in accommodations... ... telephone conversations, use of the Internet, and meetings of resident and family groups.
This requirement is not met as evidenced by:
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Administrator agreed to remove the audio until an approved waver is provided by the Community Care Licensing Division(CCLD). The Administrator shall submit a written statement that the audio component had been removed.
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Based on interviews and LPA and LPM's observation, the licensee did not comply with the section sited above by having a video surveillance equipment that is capturing audio conversation. This poses a potential health and safety risk to residents 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.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6