198603213-2-12-2025-31-AS-NMAN-DEPV2G-20250312160307

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603213
Report Date: 02/12/2025
Date Signed: 02/12/2025 10:37:02 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
12/15/2024 and conducted by Evaluator Leizl De La Cerra

COMPLAINT CONTROL NUMBER: 31-AS-20241215221640

FACILITY NAME:	COMFORT CARE ASSISTED LIVING FACILITY		FACILITY NUMBER:	198603213
ADMINISTRATOR:	AVETIKYAN, OLGA		FACILITY TYPE:	740
ADDRESS:	731 MILFORD STREET		TELEPHONE:	(747) 283-6125
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91203
CAPACITY:	6	CENSUS: 4	DATE:	02/12/2025
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Susanna Avetian, Manager		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff neglect resulted in a resident sustaining a burn.
Staff did not provide reasonable accommodation to the resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced subsequent complaint visit to this facility to investigate the above allegation and deliver findings. LPA met with facility manager, Susanna Avetian and explained the reason for the visit.

Regarding the allegation: Staff neglect resulted in a resident sustaining a burn.
To investigate this allegation LPA de la Cerra conducted an initial visit on 12/16/24 and LPA requested pertinent documents relevant to the investigation at 11:00AM, conducted and interviewed resident and facility staff member between 11:15AM – !2:15PM.
On 02/12/25, at 12:30PM LPA de la Cerra asked for the census, LIC500 and LIC9020 upon arrival. LPA interviewed additional residents, conducted a physical tour, gathered additional pertinent documents.
It was alleged that while bathing R1 on 12/11/24, staff failed to check the temperature of the water which resulted in R1 getting burns on her back and lower back side.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La Cerra	TELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

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-20241215221640

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: 02/12/2025

NARRATIVE

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Interviews with S1 and S2, revealed that the morning of 12/11/24 was the onset of R1’s diarrhea and a few more loose bowels thereafter. S2 with the help of a hospice worker - W3 repeatedly cleaned R1 by washing off the loose bowels all over R1. S1 and S2 informed LPA that during every cleaning and washing of R1, S2 and W3 constantly checked the water temperature to prevent R1 from getting scalded. In the afternoon R1 was taken to the hospital as ordered by R1's conservator (W2).
LPA de la Cerra’s review of the police investigation report dated 12/12/24 by officer (W1) from Glendale Police Department revealed that during the interview between R1 and the officer at the hospital, R1 was alleging that facility staff burned R1 on the back side of their body. The officer (W1) then stated on their police investigation report that five (5) nurses were asked to shift R1’s body to the left side and shift the body to the right side to examine R1 for burns. Officer (W1) noted on the report that all five (5) nurses and officer (W1) did not observe any burns on R1. Futhermore, LPA’s interview with R1’s conservator (W2) revealed that R1 has a history of making false allegations. Therefore, based on interviews, record reviews and observations, this allegation is deemed unsubstantiated at this time.

Regarding the allegation: Staff did not provide reasonable accommodation to the resident.
To investigate this allegation LPA de la Cerra conducted an initial visit on 12/16/24 and LPA requested pertinent documents relevant to the investigation at 11:00AM, conducted and interviewed resident and facility staff member between 11:15AM – !2:15PM.
On 02/12/25, at 12:30PM LPA de la Cerra asked asked for the census, LIC500 and LIC9020 upon arrival. At 12:30PM LPA interviewed additional staff and residents, conducted a physical tour, gathered additional pertinent documents.
It was alleged that facility did not accommodate R1 with a bed and oxygen machine. During LPA’s facility tour, LPA checked R1’s room at the facility and observed a bed. S1 also showed LPA some pictures S1 previously took of R1 laying on the assigned bed at the facility. Review of R1’s medical records revealed that there weren't any prescription for a medical oxygen machine. Furthermore, LPA’s interview with two (2) out of four (4) residents stated that the facility always provides reasonable accommodations. LPA’s interview with R1’s conservator (W2) revealed that R1 has a history of making false allegations.
Therefore, based on interviews, record reviews and observations, this allegation is deemed unsubstantiated at this time.

No health and safety hazards noted during the visit.
Exit interview conducted. Copy of this report was signed and issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Leizl De La Cerra	TELEPHONE: (818) 454-0632
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC9099 (FAS) - (06/04)

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