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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610556
Report Date: 10/15/2024
Date Signed: 10/15/2024 11:07:49 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
10/11/2024 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20241011120711
FACILITY NAME:INGOMAR ASSISTED LIVINGFACILITY NUMBER:
197610556
ADMINISTRATOR:BAREGHAMYAN, ELENFACILITY TYPE:
740
ADDRESS:19000 INGOMAR STREETTELEPHONE:
(818) 403-1803
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 6DATE:
10/15/2024
UNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Nazar Yegenyan, Administrator DesigneeTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Staff don't answer facility phone.
INVESTIGATION FINDINGS:
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At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced initial complaint visit. LPA met with the Administrator Designee, Nazar Yegenyan. LPA disclosed the reason for the visit. During course of the investigation, interviews were conducted. At 9:45 AM, LPA requested residents and staff roster. At 9:55 AM, LPA conducted a physical plant tour. Between 10:00 AM to 10:55 AM, LPA conducted an interview with the Administrator Designee, two (2) staff, three (3) out of six residents. It is alleged that the facility do not answer phone calls. To investigate this allegation LPA contacted the facility on 10/11/2024, and the facility staff member immediately answered the phone call.
Also during today’s visit the Administrator telephone rang and from the second ring the administrator answered. Additionally, LPA was provided the landline telephone number to which LPA called and it was answered.

Continue on LIC 9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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 2
Control Number 31-AS-20241011120711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: INGOMAR ASSISTED LIVING
FACILITY NUMBER: 197610556
VISIT DATE: 10/15/2024
NARRATIVE
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Moreover, LPA conducted interview and all parties interviewed denied the above allegation. Phones calls are always being answered and residents expressed no concerns regarding this allegation. Lastly, LPA conducted interview with the reporting party who denied filling a complaint against this facility and informed LPA that the complaint was filed in error. LPA have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. LPA have therefore dismissed the complaint.”

Exit interview conducted. Copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2