374604782-7-29-2025-08-AS-SJAB-DKNVJD-20250818162830

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604782
Report Date: 07/29/2025
Date Signed: 07/29/2025 12:36:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2025 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20250725154042

FACILITY NAME:	LILOS TENDER SENIOR CARE INC II		FACILITY NUMBER:	374604782
ADMINISTRATOR:	BEBEKYAN, NVARD		FACILITY TYPE:	740
ADDRESS:	4146 ROLANDO BLVD		TELEPHONE:	(818) 284-2502
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	6	CENSUS: 6	DATE:	07/29/2025
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Caregivers Jose “Manuel” Hernandez-Mendez and Licensee Anna Petrosyan		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Licensee's staff took resident's private property.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Jose “Manuel” Hernandez-Mendez. LPA also spoke briefly with Licensee Anna Petrosyan via phone during the visit.

The Complainant alleged that Licensee’s staff [Staff #1 (S1)] took resident’s [Resident #1 (R1)] private property. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of R1, S1, each of R1’s peers/housemates, and other pertinent facility staff and outside sources. The Department also reviewed the facility’s care records on R1.

[CONTINUED ON LIC 9099-C, 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025

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 3

Control Number 08-AS-20250725154042

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LILOS TENDER SENIOR CARE INC II	FACILITY NUMBER: 374604782
	VISIT DATE: 07/29/2025

NARRATIVE

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[CONTINUED FROM LIC 9099]

The Complainant claimed around 07/24/2025, S1 confiscated marijuana from R1’s bedroom table, in R1’s presence and with R1’s knowledge. The Complainant did not know the rationale for the action but made it clear that they did not suspect Licensee’s staff of taking the marijuana for personal use.

Review of R1’s latest LIC602 Physician’s Report showed that while R1 was not formally diagnosed with Dementia or Mild Cognitive Impairment (MCI), their doctor indicated that R1 did have “cognitive deficits.” Per the LIC625 Appraisal/Needs and Services Plan which Licensee authored, R1 was “forgetful at times.” R1’s medication list did not include a doctor’s order/prescription for marijuana.

Per LPA’s own interview of R1: R1 denied having Dementia or MCI, but they told LPA that they were sometimes forgetful. R1 stated that their responsible person (RP) typically brought them eight (8) buds of marijuana purchased from a dispensary store, at the beginning of every month, once per month. They said the RP would hand this quantity over to facility staff, who were responsible for centrally storing and handing R1 their marijuana (in smaller amounts) alongside their prescription medications. R1 said they typically consumed one (1) bud per day, and that they consumed marijuana on a consistent daily basis. When asked if R1 ever typically skipped days (i.e., if there were days in between when they didn’t consume marijuana), R1 said no; R1 said they asked for it every day without failure. Regarding the date in question, R1 denied S1 coming to their room to confiscate their marijuana. R1 instead said they personally handed three (3) buds of marijuana to S1 for temporary safekeeping but later could not get it back from S1, for unclear reasons. However, R1’s account of the incident contradicted the account they had earlier given to a credible and neutral third-party source, whom LPA interviewed. LPA denied staff ever taking or withholding any other personal possession from them.

In their interview with LPA, S1 denied confiscating marijuana from R1, at any time. Interviews of multiple caregivers aligned to show: R1’s RP typically visited the facility once at the beginning of each month to deliver R1’s marijuana to facility staff for central storage. Every day, staff gave marijuana in smaller increments to R1, until this supply was depleted. (Staff’s description of the approximate quantity of marijuana which RP provided to them monthly approximated the same quantity which R1 themselves said their RP delivered.) [CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20250725154042

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LILOS TENDER SENIOR CARE INC II	FACILITY NUMBER: 374604782
	VISIT DATE: 07/29/2025

NARRATIVE

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[CONTINUED FROM LIC 9099-C, 1 of 2] Staff unanimously reported that R1’s typical rate of consumption meant that their supply of marijuana would last until the 15th of the month in a best case scenario, but often ran out sooner. They said R1’s RP simply did not provide R1 enough marijuana to last R1 the whole month. They said on past occasions, when they repeatedly informed R1 that the supply was depleted, it was common for R1 to not believe them.

LPA also interviewed each of R1’s five peers/housemates; of these, one was too disoriented to answer questions. The other four residents said the facility’s staff treated them well, and each denied staff ever trying to take away or withhold their personal belongings.

Based on records and interviews, a preponderance of evidence does not exist to show that Licensee's staff took resident's private property. The allegation is therefore Unsubstantiated, and no deficiency was cited for it.

An exit interview was conducted with Licensee Anna Petrosyan and Caregiver Jose “Manuel” Hernandez-Mendez. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee during today’s visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025

LIC9099 (FAS) - (06/04)

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