197610483-3-5-2024-31-AS-RORN-D5WV9R-20240604161445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610483
Report Date: 03/05/2024
Date Signed: 03/05/2024 02:28:38 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
02/28/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20240228085822

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:	Adranik Kapikyan		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff handled resident in a rough manner
Staff did not assist resident in a timely manner
Staff did not provide adequate food service
Staff did not provide a comfortable environment for residents
Staff did not accommodate resident based on resident’s health conditions
Staff did not meet resident's diapering needs
Staff mismanaged resident medication

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, Adranik Kapikyan, and advised him of the complaint. Today's investigation consisted of interviews with the administrator, residents and staff, record review and a physical plant inspection.

Staff handled resident in a rough manner:
In regards to the allegation, it was reported that in the morning of, on or around 02/28/24, staff took a resident's cell phone away, and threw that resident back on the bed. There were no residents or witnesses identified to the allegation. Interviews with the administrator and staff deny the allegation. Interviews with three (3) of the four (4) residents could not confirm that the allegation had occurred. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff handling a resident in a rough manner. Therefore, the allegation is deemed Unsubstantiated at this time.

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-20240228085822

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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Staff did not assist resident in a timely manner/Staff did not meet resident's diapering needs:
In regards to the allegation, it was reported that on or around 02/28/24, at approximately 6:00am, a resident had a fall. This resident was left unassisted on the floor for a period of time, in their urine and feces. There were no residents or witnesses identified to these allegations. Interviews with the administrator and staff deny the allegation. Interviews with three (3) of the four (4) residents could not confirm that the allegations occurred. During interviews with these residents, it was revealed that each resident is able to go to the bathroom or take care of their toileting needs on their own. In addition to these interviews, LPA reviewed each resident files, and it revealed that all the residents can manage their own toileting needs. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not assisting a resident in a timely manner, or staff not meeting a resident's diapering need. Therefore the allegations are deemed Unsubstantiated at this time.

Staff did not provide adequate food service:
In regards to the allegation, it was reported that the facility does not provide a balanced meal, serving mostly burned toast and baloney. Interviews with the administrator and staff deny the allegation. Interviews with three (3) of the four (4) residents also deny the allegation. Residents did not express any concerns of the food service, stating they are satisfied with what's being served. In addition to interviews, LPA conducted an inspection of the food supply and observed a variety and sufficient supply of perishable and non-perishable food. During the day's visit, LPA observed lunch, which is chicken stew, consisting of carrots, potato and rice. Based on the information obtained, the allegation of staff did not provide adequate food service is deemed Unsubstantiated at this time.

Staff did not provide a comfortable environment for residents:
In regards to the allegation it was reported that Staff 1 (S1) disturbs residents in the morning by intentionally talking loud and turning up the radio and television to wake them up by 5am. Interviews with the administrator and staff deny the allegation. During LPA's interview with S1, S1 was observed to be soft spoken. Interviews with three (3) of the four (4) residents also deny the allegation, and expressed no complaints towards S1. Based on the information obtained, the allegation of staff not providing a comfortable environment 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)

Page: 2 of 3

Control Number 31-AS-20240228085822

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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Staff did not accommodate resident based on resident’s health conditions/Staff mismanaged resident medication:
In regards to the allegations, it was reported that the licensee admitted a resident who requires a higher level of care, and 24 hour supervision. It was also reported that resident medications are mismanaged. The reporting party did not identify this resident, or the conditions requiring the higher level of care. Nor did the reporting party identify residents whose medications were mismanaged. Interviews with the administrator and staff deny the allegation. There are no residents at the facility with a restricted or prohibited condition. Interviews with three (3) of the four (4) residents expressed no complaints or concerns with staff ever mismanaging their medications. During LPA's physical plant inspection, LPA observed the residents at the home to be appropriate and aware of their surroundings. Only one resident was observed to require the use of a wheelchair, but this resident was able to manage their own needs. In addition, LPA conducted a record review of resident records and did not observe any of the resident records indicating the need for 24 hour supervision, or a higher level of care. Medications were also reviewed, and no discrepancies were observed. Based on the information obtained, there was insufficient evidence to corroborate the allegations of staff not being able to accommodate a resident's health needs, or staff mismanaging a resident's medication. Therefore, the allegations are 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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