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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603605
Report Date: 07/24/2024
Date Signed: 07/24/2024 11:46:14 AM

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
06/13/2024 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20240613104442
FACILITY NAME:ARARAT GARDENSFACILITY NUMBER:
198603605
ADMINISTRATOR:KESHISHYAN, VARSENIKFACILITY TYPE:
741
ADDRESS:1230 EAST WINDSOR ROADTELEPHONE:
(818) 244-7219
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:175CENSUS: 78DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Edemida Vasquez- LVNTIME COMPLETED:
12:37 PM
ALLEGATION(S):
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Staff does not ensure resident's pendent and call button is in good repair.
INVESTIGATION FINDINGS:
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On 7.24.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced subsequent visit to deliver the determination on the above allegations. LPA was greeted by Edemida Vasque (S2) the License Vocational Nurse (LVN) of the facility; execitive director (ED-S1) was on maternity leave.

At 10 AM LPA conducted a physical plant tour to ensure the health and safety of the residents in care.

Allegation: Staff does not ensure resident's pendent and call button is in good repair.

It was alleged that the facility staff did not respond to residents' pendants and emergency pull cords promptly. On 06.19.2024 LPA Leslie Ngo-Castaneda initiated this investigation into the complaint.
Continue to LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-CastanedaTELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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 5
Control Number 31-AS-20240613104442
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: ARARAT GARDENS
FACILITY NUMBER: 198603605
VISIT DATE: 07/24/2024
NARRATIVE
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 LPA requested and reviewed the staff roster, resident roster, residents’ physician’s report, admissions agreement, appraisals, and incident reports.

LPA interviewed residents, fourteen (14) out of seventy-two (72) residents and six (6) out of twenty-five (25) staff. While interviewing residents, LPA randomly tested residents’ pendants and emergency call buttons in bathrooms and bedrooms. LPA conducted a random inspection of one (1) pendant one (1) emergency pull cords in the bathroom, and one (1) emergency pull cords in the bedroom. During the inspection one (1) pendant call was received by the facility and a caregiver responded to the call in eight (8) minutes and four (4) minutes consecutively. However, at 11:30 AM, LPA tested the residents' pendant and emergency cord in room #122 and waited until 11:50 AM. No staff showed up to reset the call buttons. Based on LPA's observation and review of the information received this allegation is Substantiated.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D).

Exit interview conducted. Copy of this report issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-CastanedaTELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20240613104442
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: ARARAT GARDENS
FACILITY NUMBER: 198603605
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/25/2024
Section Cited
CCR
87468.1
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Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful, and comfortable accommodations,
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The Licensee/Administrator provided in-service training to all staff. A copy of the training will be submitted to LPA. Cleared during LPA visit.
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 furnishings, and equipment. Based on LPA inspection the licensee did not comply with the section cited above. Staff did not respond to 1 out of 3 emergency devices, which poses/posed a potential health and safety risk to persons in care.
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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: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-CastanedaTELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/13/2024 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20240613104442

FACILITY NAME:ARARAT GARDENSFACILITY NUMBER:
198603605
ADMINISTRATOR:KESHISHYAN, VARSENIKFACILITY TYPE:
741
ADDRESS:1230 EAST WINDSOR ROADTELEPHONE:
(818) 244-7219
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:175CENSUS: 78DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Edemida Vasquez- LVNTIME COMPLETED:
12:37 PM
ALLEGATION(S):
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9
Staff does not seek medical attention to residents in a timely manner.
INVESTIGATION FINDINGS:
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At 10 AM LPA conducted a physical plant tour to ensure the health and safety of the residents in care.

Allegation: Staff does not seek medical attention to residents in a timely manner.

It was alleged that the facility staff did not seek medical attention in a timely manner. On 06.19.2024 LPA Leslie Ngo-Castaneda initiated this investigation into the complaint. LPA requested and reviewed the staff roster, resident roster, residents’ physician’s report, admissions agreement, appraisals, and incident reports.

LPA interviewed residents, fourteen (14) out of seventy-two (72) residents and six (6) out of twenty-five (25) staff. Regarding this allegation, it was reported that Resident #1 (R1) was not given medical attention when the call button was pressed.

Conitnue to LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-CastanedaTELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20240613104442
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: ARARAT GARDENS
FACILITY NUMBER: 198603605
VISIT DATE: 07/24/2024
NARRATIVE
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LPA interviewed the Executive Director, License Vocational Nurse (LVN), and R1 and it was revealed that paramedics were called immediately after responding to the call button in R1 bathroom in room #205. Furthermore, it was revealed that medical assistance such as calling 9-1-1 during an emergency has been used for all residents when needed. Resident interviews also revealed that they also have access to call 911 if they need to. Therefore, based on LPA observations, record reviews, and interviews this allegation is deemed Unsubstantiated.

No health and safety issues were noted at the time of this visit. An exit interview was conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-CastanedaTELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5