198603100-1-23-2025-31-AS-NMAN-DGNU64-20250514151742

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603100
Report Date: 01/23/2025
Date Signed: 01/23/2025 03:28:07 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
12/19/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20241219122415

FACILITY NAME:	NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC		FACILITY NUMBER:	198603100
ADMINISTRATOR:	TOPADZUIKYAN, EMMA		FACILITY TYPE:	740
ADDRESS:	1444 WESTERN AVE		TELEPHONE:	(818) 245-6614
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91201
CAPACITY:	5	CENSUS: 3	DATE:	01/23/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Maria Sereno		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff refusing to allow resident to have visitor(s).
Staff does not allow resident to use the phone.
Staff did not follow medication administration procedures.
Staff did not provide resident with a copy of the admissions.
Staff are not preventing residents from disturbing other resident
Staff does not meet residents hidriation needs
Food service requirments were not followed
Facility has pests
Staff pushed resident

INVESTIGATION FINDINGS:

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At 2:00 p.m. on 01/23/25, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with staff and disclosed the reason for the visit.

To investigate the allegations above, LPA conducted an initial visit on 12/20/24 and toured the facility inside and out at 10:00 a.m., interviewed staff and residents between 10:05 a.m. and 12:00 p.m., and conducted a record review of pertinent records, including but not limited to an admission agreement, medical assessment, and hospital discharge paperwork at 11:00 a.m. LPA conducted another visit on 01/03/25 and interviewed staff and residents between 1:30 p.m. and 2:45 p.m., conducted a record review of pertinent records at 2:00 p.m., and toured the facility inside and out at 1:30 p.m. Today, LPA toured the facility at 2:00 p.m.

Regarding the allegation "Staff refusing to allow resident to have visitor(s)" it was alleged Staff #1 (S1) would not allow Visitor #1 (V1) of Resident #1 (R1) into the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

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 4

Control Number 31-AS-20241219122415

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC	FACILITY NUMBER: 198603100
	VISIT DATE: 01/23/2025

NARRATIVE

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Interview with the administrator at 10:30 a.m. on 12/20/24 revealed R1 came from a rehab center. A social worker at the rehab center informed the administrator that R1 expressed they did not want to see V1. Therefore, the administrator instructed staff to ask R1 if they wanted to meet with V1 each time V1 came to the facility. Interview with R1 at 11:30 a.m. on 12/20/24 revealed they had no problem with V1. Interview with S1 at 10:15 a.m. on 12/20/24 confirmed they asked R1 if they wanted to meet with V1 and did not allow V1 in if R1 did not want to see V1. Interviews with two (02) out of three (03) other residents revealed they have no issues with visitation. Based on interviews, staff allowed residents to have visitors when they desired. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff does not allow resident to use the phone" it was alleged the facility phone was not available for R1 and may be in disrepair. LPA called the house phone at 9:50 a.m. on 12/20/24 and staff answered. The house phone was deemed operational. Interview with S1 revealed the house phone works fine, and residents use it often. Interview with R1 revealed they don’t know where their personal phone is, so they use the house phone. Two (02) out of three (03) other residents interviewed confirmed they use the house phone, and it works. Interview with the administrator revealed all residents are allowed to use the house telephone and that it is operational. LPA heard two (02) incoming calls on the house telephone during a visit on 01/03/25. Based on observations and interviews, the house telephone works and residents have no issue using it. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff did not follow medication administration procedures" it was alleged R1 did not receive some of their medications since refills were not picked up. Record review of R1’s medication list indicated that R1 was admitted to the facility on 08/12/24 with approximately a one month supply of medications. Interview with the administrator revealed R1 received all prescribed medications. Interview with S1 confirmed that they picked up R1’s medication refills each month from the pharmacy. Interviews with two (02) out of three (03) other residents revealed they received all medications without issues. Based on interviews and record review, the facility followed resident medication administration procedures. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff did not provide resident with a copy of the admissions" it was alleged R1 did not receive a copy of their admission agreement. Interview with R1 revealed they never requested a copy of the admission agreement. Interview with the administrator revealed R1 signed their admission agreement along with their representative in August 2024.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20241219122415

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC	FACILITY NUMBER: 198603100
	VISIT DATE: 01/23/2025

NARRATIVE

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The administrator noted R1 never requested a copy of the contract, and it was available in the facility. The administrator also stated that V1 requested a copy of R1’s admission agreement. Since V1 did not represent R1 and was not present for R1’s admission process, the administrator did not provide a copy of the contract to V1. Record review revealed that R1 and their representative signed R1’s admission agreement, and V1’s name or signature was not on any of R1’s documents. Based on interviews and record review, R1 never requested a copy of their admission agreement, and staff did not refuse to provide it. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff are not preventing residents from disturbing other resident" it was alleged R1’s roommate, Resident #2 (R2), engaged in behaviors which disturbed R1. Interview with R1 revealed R2 does not bother them. Interviews with two (02) out of three (03) other residents revealed they get along fine with their housemates. Interview with the administrator and S1 revealed they had not seen R2 disturbing R1. The administrator did not receive any complaints from R1 about R2 either. Instead, R2 told the administrator that R1 was disturbing them at night. LPA did not observe any disturbing behavior during visits on 12/20/24, 01/03/25, or today. Based on observations and interviews, no residents are disturbing other residents. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff does not meet resident’s hydration needs" it was alleged R1’s water bottle cap was dirty and residents are not encouraged to drink water. Interview with the administrator revealed that all residents have water bottles which are checked hourly and filled as necessary. Staff check residents every twenty (20) minutes to encourage hydration. Interview with S1 confirmed that they provide clean water every hour and encourage residents to stay hydrated. LPA observed S1 filling resident water bottles around 1:00 p.m. on 01/03/25. Interview with R1 revealed they have no problem drinking enough water and no problem with their water bottle. LPA inspected R1’s bottle cap around 11:45 a.m. on 12/20/24. The bottle cap was clean and free from debris. Interviews with three (03) out of three (03) other residents revealed they drink enough water. Based on observations and interviews, staff meet resident hydration needs. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Food service requirements were not followed" it was alleged the facility food served was not nutritious. LPA observed sufficient supplies of perishable and non-perishable food during the facility tour on 12/20/24. Interview with R1 revealed they ate toast with peanut butter and jelly for breakfast on 12/20/24, but they found the food was “not too interesting” and wanted more interesting food.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 31-AS-20241219122415

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC	FACILITY NUMBER: 198603100
	VISIT DATE: 01/23/2025

NARRATIVE

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Interviews with three (03) out of three (03) other residents revealed they felt the facility food was fine. Interview with S1 revealed they follow R1’s vegetarian diet and served yogurt, oatmeal, and peanut butter on toast for breakfast on 12/20/24. S1 stated R1 had a good appetite and had never previously expressed problems with the food served. Interview with the administrator revealed they also had not received any complaints about the food served. Based on observations and interviews, although the allegation is valid, there was no evidence indicating the facility did not follow food service requirements. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Facility has pests" it was alleged a cockroach was seen in the facility. LPA did not observe any pests or signs of pests during facility tours on 12/20/24, 01/03/25, or today. Interviews with four (04) out of four (04) residents interviewed revealed they had not seen any cockroaches or other pests besides one (01) fly. Interview with Resident #3 (R3) at 2:25 p.m. on 01/03/25 revealed they see a fly sometimes, but staff take care of it “pretty quickly”. Interviews with S1 and the administrator revealed they had not seen any pests in the facility and clean often. Based on observations and interviews, although the allegation is valid, there is no evidence indicating the facility has pests. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation "Staff pushed resident" it was alleged S1 pushed R1. Interview with R1 revealed they were never pushed by S1 or any other staff. Interview with S1 revealed they nor other staff ever pushed or mistreated residents. Interviews with three (03) out of three (03) other residents interviewed revealed staff had not pushed them or handled them in a rough manner. Interview with the administrator revealed no residents had been pushed or mishandled at the facility. LPA observed staff treating residents appropriately during tours on 12/20/24, 01/03/25, and today. Based on observations and interviews, although the allegation is valid, there is no evidence suggesting staff pushed a resident. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety concerns were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4