198603100-3-12-2024-31-AS-NMAN-D9XQJ2-20241011121202

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603100
Report Date: 03/12/2024
Date Signed: 03/12/2024 02:40:03 PM

Substantiated

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
03/01/2024 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20240301091558

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: 5	DATE:	03/12/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Emma Topadzuikyan, Licensee		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Licensee became power of attorney of a resident

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Rosaura Valenzuela, Leizl De La Cera, Milena Khurshudyan and Licensing Program Manager (LPM) Naira Margaryan conducted an unannounced subsequent visit to deliver the findings for the above noted allegation. LPAs and LPM met with Licensee Emma Topadzuikyan and explained the reason for the visit.

It was reported that Licensee became power of attorney of a resident #1 (R1). To investigate this allegation on 3/06/2024, LPAs Valenzuela and De La Cera made an unannounced initial visit. Between 11:00am and 11:30am, a physical tour was conducted. LPAs observed five residents in care. Between 11:30am and 1:15pm, facility records were reviewed. LPAs noted that facility files were incomplete. As per LPAs request, on 3/08/2024, Licensee emailed facility records for Resident #1 (R1) to LPA Valenzuela. Records requested included, but not limited to R1's physician's report, need and service plan, emergency contact information, a copy of R1's Durable Power of Attorney (POA) and etc. On 3/06/2024, between 1:15pm and 1:30pm , resident interviews were initiated. Interviews did not reveal anything since R1 was not able to respond to the
Continue on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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-20240301091558

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: NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC	FACILITY NUMBER: 198603100
	VISIT DATE: 03/12/2024

NARRATIVE

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questions. From 1:30pm to 2:30pm, LPAs initiated staff interviews. At the time of the interview the Administrator, Staff #1 (S1) admitted that after R1 moved to the facility, they became R1's medical and financial durable power of attorney. Prior to this visit, on 3/11/2024, between 1:00pm and 3:00pm, LPA reviewed the facility records. Records revealed that S1-Licensee/Administrator is R1's medical and financial POA. Furthermore, records also revealed that an unknown individual, who has no connection to R1 is also listed as on of the Power of Attorneys for R1.

Based on interviews and records review there is sufficient information to verify this allegation. Therefore, this allegation is SUBSTANTIATED at this time.

Pursuant to the California Code of Regulations, Title 22, the following deficiencies were observed and cited during this visit.

No other health and safety hazards are noted during this visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240301091558

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: NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC	FACILITY NUMBER: 198603100
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/12/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/13/2024 Section Cited HSC 1569.58(a)(5)	1 2 3 4 5 6 7	1569.58 Persons prohibited from being a licensee, owning beneficial interest in licensed facility-(a) The Department may prohibit any person from being a licensee...or being an administrator, member, or manager of a licensee...and my further prohibit any licensee from employing, or continuing the	1 2 3 4 5 6 7	The Licensee will submit written sttement explaining the steps she will take to remedy the cituation. The document must be submitted to the Licensing Department within 24 hours,
	8 9 10 11 12 13 14	employment of...or allowing contact with clients of a licensed facility...who has done any of the following: (5) Engaged in acts of financial malfeasance concerning the operaton of a facility, including but not limited to, improper use or embezzlement of client moneys and property or fraudulent appropiattion for personal gain of facility moneys and property. This requirement was not met as evidenced by: Based on interviews and records review, the Licensee became R1's health care and financial power of attorney. This posses an immidiate health and safety risk to resident in care.	8 9 10 11 12 13 14
Type A 03/13/2024 Section Cited CCR 87217(d)(2)(f)	1 2 3 4 5 6 7	87217(d)(2)(f) Safeguards for Resident Cash, Personal Property, and Valuables (d)(2)...no licensee or employee of a facility shall; accept any general or special power of attorney for any resident. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Licensee will submit written sttement explaining the steps she will take to remedy the cituation. The document must be submitted to the Licensing Department within 24 hours,
	8 9 10 11 12 13 14	Based on interviews and records review the Licensee became R1's POA. This poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC9099 (FAS) - (06/04)

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