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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610499
Report Date: 08/27/2024
Date Signed: 08/27/2024 01:59:27 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.ASC, 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
05/10/2024 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20240510150051
FACILITY NAME:LOS ANGELES BOARD AND CAREFACILITY NUMBER:
197610499
ADMINISTRATOR:ARZUMANYAN, ANUSHFACILITY TYPE:
740
ADDRESS:15214 CHATSWORTH STREETTELEPHONE:
(424) 666-5666
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY:6CENSUS: 6DATE:
08/27/2024
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Anush Arzumanyan - Asst. AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yelled at a resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with Assistant Administrator Anush Arzumanyan and explained the reason for the visit.

LPA conducted physical plant tour at 9:12 AM, requested copies of facility documents relevant to the investigation at 9:49 AM and interviewed residents and staff between 10:00 AM to 12:30 PM. It was alleged that on 05/10/24 Resident #1 (R1) was on the phone and was yelled at by the staff and was told to go outside. LPA's closed-circuit television (CCTV) review on 05/17/24 revealed that it was R1 who yelled at the staff when the staff tried to assist R1. LPA interview with residents on 05/17/24 between 9:30 AM to 11:00 AM and today between 10:00 AM to 12:30 PM, revealed that five (5) out of five (5) aware residents were not yelled at by any staff nor witnessed any staff yelled at any resident and stated that staff are respectful and provide all the care they need. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
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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