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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850400
Report Date: 07/01/2024
Date Signed: 07/01/2024 04:55:06 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
06/25/2024 and conducted by Evaluator Valeria Conway
COMPLAINT CONTROL NUMBER: 29-AS-20240625130611
FACILITY NAME:BALANCED LIVING BOARD AND CAREFACILITY NUMBER:
565850400
ADMINISTRATOR:AVETYAN, SMBATFACILITY TYPE:
740
ADDRESS:1430 CALLE MADRESELVATELEPHONE:
(626) 200-5821
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:6CENSUS: 1DATE:
07/01/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alvard Galstyan - CaregiverTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility did not ensure that staff can effectively communicate with a resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced initial 10-day complaint visit to the above facility. Upon arrival, LPA was greeted by facility staff Alvard Galstyan. Staff Galstayan contacted facility Administrator/Licensee Representative Amaliya Santiago via phone and the reason for the visit was explained. Administrator/Licensee Representative informed LPA that she, along with the other three (3) designated administrators are unable to be present during today’s visit and authorized facility staff Galstayan to sign and receive report.
It was alleged that facility staff are unable to communicate with resident due to a language barrier. During today’s visit, at 12:05 p.m., LPA interviewed facility resident and staff. At 9:56 a.m., LPA also conducted a phone interview with facility administrator Mr. Avetik Avo Avetyan. Additionally, LPA conducted interviews with witnesses at 10:03 a.m. and at 11:35 a.m. Information gathered during the course of the investigation reflected that Staff #1 (S1) can only communicate in Spanish, Russian and Armenian; however, cannot communicate in English.
Continued on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
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 3
Control Number 29-AS-20240625130611
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BALANCED LIVING BOARD AND CARE
FACILITY NUMBER: 565850400
VISIT DATE: 07/01/2024
NARRATIVE
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Continued from LIC 9099

Upon LPA’s arrival to the facility, S1 admitted that they did not speak English and inquired if the LPA spoke Spanish. Moreover, interviews further reflected that the residents and witnesses are also unable to communicate with S1, and if they had concerns, they would contact the administrator via phone. It was also revealed that S1 would contact the administrator to translate. Based on the information gathered during the course of the investigation, the Department has sufficient evidence to determine that the facility staff are unable to communicate with resident due to language barrier. Therefore, the above allegation is deemed SUBSTANTIATED at this time.

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

A telephonic exit interview was conducted with facility's Licensee and Administrator. A hard copy of the report was provided. A copy of the report and appeal rights was issued.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240625130611
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BALANCED LIVING BOARD AND CARE
FACILITY NUMBER: 565850400
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2024
Section Cited
CCR
87411(d)(3)
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87411(d)(3) Personnel Requirements: All personnel shal... This training and/or related experience shall provide knowledge of and skill in the following... (3) Skill... including the ability to communicate with residents. This requirement is not met as evidenced by…
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Administrator is looking for a new staff member that speak English. Rabbit devise was purchased to facilitate communication. A in-job-trainig log will be provided by POC due date on how to use devise.
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Based on observation, and interviews, licensee did not comply with the above section by not ensuring Staff #1 (S1) is able to communicate with facility residents and other parties, which poses a potential health, safety and personal rights risk to resident 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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3