361880781-8-8-2023-56-AS-NBRN-CUTM2U-20230818091408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880781
Report Date: 08/08/2023
Date Signed: 08/08/2023 01:02:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/26/2023 and conducted by Evaluator Amber Coleman

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230626081904

FACILITY NAME:	DIGNITY ADULT DAY CARE		FACILITY NUMBER:	361880781
ADMINISTRATOR:	KARAPETYAN, ALINA		FACILITY TYPE:	775
ADDRESS:	4110 HOLT BLVD, UNIT B		TELEPHONE:	(909) 447-1313
CITY:	MONTCLAIR	STATE: CA	ZIP CODE:	91763
CAPACITY:	50	CENSUS:	DATE:	08/08/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Arman Nargizian, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff threatened client in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst, Amber Coleman (LPA) arrived at the Dignity Adult Day Program to deliver the findings of the complaint investigation. LPA introduced self and stated purpose of the visit. LPA met with Administrator, Arman Nargizian.

It is alleged that staff threatened a client in care. During, staff interviews it was discovered that the Adult Day Program cares for clients with diagnosis that include developmental delay, hard of hearing and non-verbal. In April 2023, an incident occurred between two of the clients. The facility met with both of the client’s family and support workers to put treatment and prevention measures in place. This was done in efforts to discourage the clients from having interaction and to avoid any issues in the future. All staff and family agreed with the plan. All staff denied threatening the clients or threatening to call the Police on the clients. What was discussed with the clients, is that if they don’t improve their negative behaviors and...

Please see LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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 56-AS-20230626081904

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DIGNITY ADULT DAY CARE	FACILITY NUMBER: 361880781
	VISIT DATE: 08/08/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

follow the rules; their family would be notified. As time progressed, the facility became aware the incidents that occurred between the two clients was being investigated further. As a result, the two clients were asked to hold off on attendance until the investigation could be completed.

According to witnesses, there was a history of negative behaviors between the two clients, prior to the incident in April. Family went to the facility met with staff to address the issues they were having with the client while attending day program. Facility staff and the family were all in agreement. Sometime later, the facility contacted the family and asked that they hold off on the client attending program until an investigation was complete. When the news was relayed to the client, he became very upset and required psychiatric evaluation.

At this time, neither of the clients are attending the program and have no intentions of returning to the program. LPA was unable to interview the other party involved. Based on interviews and observations, we have found the complaint allegation is unsubstantiated, although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2