197610495-12-3-2024-31-AS-MSPH-DBLU2S-20241203141224

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610495
Report Date: 12/03/2024
Date Signed: 12/03/2024 02:12:32 PM

Document Has Been Signed on 12/03/2024 02:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ROSSMOYNE HILLS		FACILITY NUMBER:	197610495
ADMINISTRATOR/ DIRECTOR:	AVETISYAN, ARMINE		FACILITY TYPE:	740
ADDRESS:	1227 CAMPBELL STREET		TELEPHONE:	(747) 338-8394
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91207
CAPACITY: 6		CENSUS:	DATE:	12/03/2024
TYPE OF VISIT:	Office	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Armine Avetisyan		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An informal meeting was held today at the Woodland Hills Regional Office. The purpose of this meeting was to discuss recent issues of non-compliance. Present at today’s meeting were: Armine Avetisyan, Administrator, Albert Khachatryan, Licensee, Knarik Panossyan, Previous staff member, Angela Whittaker, Regional Manager (RM) , Eva Miller, Licensing Program Manager (LPM), and Licensing Program Analyst (LPA) Melissa Spaeth. The informal conference process was explained to the Administrator. Additionally, they were also informed that this Informal Conference is part of the administrative action process and that further non-compliance and/or citations would result in requiring the attendance at a Non-Compliance Conference meeting. Rossmoyne Hills was licensed on 04/30/2024. From the date the facility was licensed to present, the Regional Office (RO) received three (3) complaints. Two (2) out of three (3) complaints have been found Substantiated. On 08/15/2024, LPA Duguma conducted an unannounced initial complaint visit. LPA announced their name, department and explained the reason for the visit with badge in plain sight. Shortly after entering the facility, the Administrator requested details about the complainant and alleged victim over speaker phone. LPA again explained the reason for the visit and that more information will be disclosed as it is an on-going investigation. The Continued on 809-C

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROSSMOYNE HILLS	FACILITY NUMBER: 197610495
	VISIT DATE: 12/03/2024

NARRATIVE

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Administrator then began shouting to the caregiver, “call the police, call the police”. Moments later the police arrived at the facility and LPA was put through unnecessary questioning. Due to harassment, a lack of cooperation and courteousness, the visit was terminated.

On 10/30/24, LPA Duguma conducted an unannounced subsequent complaint visit. LPA announced their name, department and explained the reason for the visit with badge in plain sight. During the visit, caregiver refused to answer questions and identify themselves. The Administrator was again contacted and placed on speaker. Both the Administrator and caregiver made accusation of LPA being racist and making fun of staff. Due to harassment, a lack of cooperation and courteousness, the visit was terminated.

During today’s conference, the following matters were discussed:

Title 22, Division 6, Chapter 8, Article 13. Enforcement
87755 Inspection Authority of the Licensing Agency

(a) Any duly authorized officer, employee or agent of the licensing agency may, upon proper identification and upon stating the purpose of his/her visit, enter and inspect the entire premise of any place providing services at any time, with or without advance notice.

(b) The licensee shall ensure that provisions are made for private interviews with any resident or any staff member; and for the examination of all records relating to the operation of the facility.

(c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b).

Continued on 809-C

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROSSMOYNE HILLS	FACILITY NUMBER: 197610495
	VISIT DATE: 12/03/2024

NARRATIVE

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It was discussed the Administrator will ensure facility staff receive training regarding the purpose of Community Care Licensing visits and to allow access to the facility. Also, the Administrator will ensure the divider located within the living room area is removed. The Administrator was advised to have a back-up Administrator for the facility and provide a copy of the Administrator Certificate to Community Care Licensing.

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

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

LIC809 (FAS) - (06/04)

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