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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603213
Report Date: 05/29/2024
Date Signed: 05/29/2024 11:34:41 AM

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
05/22/2024 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20240522222103
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: 5DATE:
05/29/2024
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Susanna Avetikyan, ManagerTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Staff unlawfully evicted a resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation, LPA met wiith Manager Susanna Avetikyan and explained the reason for the visit.

It was reported that staff unlawfully evicted a resident. To investigate this allegation on 05/29/24 between 10:45am and 11:00am, staff interviews were intitiated. Interviews revealed that staff did not evict Resident #1 (R1). R1 was sent to the hospital on 5/19/24, due to expolosive diarrhea, and once there the hospital refused to disclose their diagnosis. Facility requested many times for R1's information to be provided, but it was not. Staff told hospital that they could not accept R1 until their diagnosis was disclosed. On 5/21/23, R1's responsible party came to the facility and collected their belongings.

Based on interviews, there is not sufficient information to support this allegation. Hence, this allegation is UNSUBSTANTIATED.


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: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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-20240522222103
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: 05/29/2024
NARRATIVE
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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: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2