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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603213
Report Date: 05/21/2024
Date Signed: 05/21/2024 12:09:45 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.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
05/20/2024 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20240520133124
FACILITY NAME:COMFORT CARE ASSISTED LIVING FACILITYFACILITY NUMBER:
198603213
ADMINISTRATOR:AVETIKYAN, OLGAFACILITY TYPE:
740
ADDRESS:731 MILFORD STREETTELEPHONE:
(747) 283-6125
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY:6CENSUS: 6DATE:
05/21/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Susanne Avetian, ManagerTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not ensure resident's toileting needs were properly met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegatoin. LPA met with Manager Suzanne Avetian and explained the reason for the visit.

It was reported that staff did not ensure resident's toileting needs were properly met. Resident #1 (R1) has had uncontrolled diarrhea and vomiting for approximately two weeks. To investigate this allegation on 5/21/2024, between 10:30am and 11:15am, staff interviews were initiated. Interviews revealed that R1 has been a resident at the facility for less than a month. About two weeks ago, R1 developed uncontrolled diarrhea. Staff has been doing there best to meet R1's toiletting needs by changing the diaper as often as needed and cleaning them. On 5/19/2024, R1 was sent to the hospital with the consent of their next of kin. R1's responsible party refuses to disclose theiir medical diagnosis to staff. Facility staff d0 not know what is wrong with R1. Between 11:20am and 11:40am, LPA reviewed facility records. Records confirmed what staff told LPA.

Continue on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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-20240520133124
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: COMFORT CARE ASSISTED LIVING FACILITY
FACILITY NUMBER: 198603213
VISIT DATE: 05/21/2024
NARRATIVE
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Based on interviews and records review there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

No health and safety issues noted at the time of this visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2