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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850141
Report Date: 06/22/2022
Date Signed: 06/22/2022 05:59:18 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/14/2022 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20220614084321
FACILITY NAME:AEGIS LIVING VENTURAFACILITY NUMBER:
565850141
ADMINISTRATOR:KAREN G GOROYANFACILITY TYPE:
740
ADDRESS:4964 TELEGRAPH ROADTELEPHONE:
(805) 650-1114
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:100CENSUS: 77DATE:
06/22/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Karen G. GoroyanTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision resulted in resident eloping from facility
Facility did not report elopement incident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Zabel Chochian conducted a complaint visit to this facility to investigate the above allegations. At approximately 11:50am, LPA met with Mark Brassfield, Health Service Director and Karen G. Goroyan, Executive Director/Administrator. Reason for the visit was explained.

Between 12-12:30pm, LPA reviewed facility records and obtained copies of pertinent documents relevant to the investigation. LPA also conducted interview with facility staff and resident #1 from 12:30pm-1pm.
Record review revealed that Resident #1 (R1) resides in the Assisted Living section and is able to leave the facility unassisted. Records reviewed reflect R1 is responsible for self and no other contact person is listed for R1 on record. Interviews conducted confirmed R1 is self responsible and able to leave facility unassisted.
Based off the information obtained, the allegations are deemed unfounded at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Exit interview conducted and a copy of report issued (email).
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
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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