197610483-3-5-2024-31-AS-RORN-D5SUSC-20240531155008

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610483
Report Date: 03/05/2024
Date Signed: 03/05/2024 02:08:43 PM

Unsubstantiated

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
03/01/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20240301105312

FACILITY NAME:	LIFELONG SENIOR LIVING		FACILITY NUMBER:	197610483
ADMINISTRATOR:	KAPIKYAN, ANDRANIK		FACILITY TYPE:	740
ADDRESS:	16003 LUDLOW ST		TELEPHONE:	(818) 371-5979
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 4	DATE:	03/05/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Andranik Kapikyan		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility illegally evicted resident.
Facility placed a camera in a resident's room without notifying the resident.
Facility placed a camera inside of a bathroom.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Andranik Kapikyan, and advised him of the complaint. Today's investigation consisted of interviews with the administrator, record review and a physical plant inspection.

Facility illegally evicted a resident:
In regards to the allegation, it was reported that after R1's medical appointment on or around 03/01/24, R1 was asked not to return. Interview with the administrator deny the allegation. According to the administrator, on 03/02/24, R1 was exhibiting an aggressive behavior, which was causing a distrubance at the facility. Department of Mental Health and Law Enforcement were called for assistance. R1 was placed on a 5150 hold. R1 is still placed on 5150 hold at this time. Administrator stated they are awaiting discharge, but also stated an eviction was previously issued prior to the incident on 03/02/24 for faillure to comply with the

Unsubstantiated

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: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

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-20240301105312

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: 197610483
	VISIT DATE: 03/05/2024

NARRATIVE

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house rules and the admission agreement. Based on the information obtained, the allegation of facility illegally evicting the resident is deemed Unsubstantiated at this time.

Facility placed a camera in a resident's room without notifying the resident/Facility placed a camera inside of a bathroom:
In regards to the allegation, a physical plant inspection was made, and there were only cameras in the common areas. There were no cameras installed in resident rooms or the bathrooms. Interviews with the administrator and staff deny cameras ever being installed in the resident rooms or bathrooms. Interviews with three (3) of four (4) residents also deny that there is a camera in their room, or in the bathroom. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

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