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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850434
Report Date: 03/20/2025
Date Signed: 03/20/2025 03:20:51 PM

Unsubstantiated


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
02/21/2025 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20250221163141
FACILITY NAME:SENIORS DIGNITY CAREFACILITY NUMBER:
565850434
ADMINISTRATOR:MANUKYAN, ANAHITFACILITY TYPE:
740
ADDRESS:6306 MARSHA AVETELEPHONE:
(805) 624-7109
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:6CENSUS: 6DATE:
03/20/2025
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Nurzhan MamatovaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not assist resident with their auditory prosthetics.
Staff spoke inappropriately to resident.
Staff did not meet resident’s grooming needs.
Staff left resident in the same clothing for extended periods.
Staff did not dispense medication to resident as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial complaint visit was conducted on 02/26/2025 by LPA M. Arroyo. On today's visit, LPA Arroyo met with staff, Nurzhan Mamatova and shared findings with the Administrator telephonically. Entrance interview.

During the initial visit on 02/26/2025, the LPA conducted a plant tour at 11:10AM, conducted a medication review at 11:30AM, conducted interviews with one staff and four residents between 11:13AM and 2:35PM, and conducted a file review and obtained copies of pertinent documents.

Report Continued on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
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 29-AS-20250221163141
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SENIORS DIGNITY CARE
FACILITY NUMBER: 565850434
VISIT DATE: 03/20/2025
NARRATIVE
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Report Continued from LIC 9099...

It was alleged that staff did not assist resident with their auditory prosthetics. It was reported that only one (1) hearing aid is working due to facility staff being too busy to assist Resident #1 (R1) in charging their hearing aids. Interviews conducted with staff revealed that R1 is able to put on their hearing aids independently in the mornings. However, R1 was struggling to place the hearing aids back into the charger at night. Staff noted that, due to R1's difficulty with the charger, they decided to charge the hearing aids every night. During the interviews, R1 mentioned that the facility staff charges their hearing aids each night and stated that the staff is helpful. Additionally, residents reported having no concerns about living at the facility and noted that the staff is able to assist if needed. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegation of “staff did not assist resident with their auditory prosthetics”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that staff spoke inappropriately to resident. It was reported that facility staff is short tempered and yells at the residents. Interviews conducted with staff revealed that they were unaware of any residents feeling disrespected. Staff stated that residents have not reported instances of staff being rude or yelling at them. Interviews with residents revealed that they find the staff to be nice and polite when assisting them. Additionally, during the interviews, residents denied feeling disrespected by staff while living at the facility and stated that staff has never been rude to them. Furthermore, residents reported having no concerns about living at the facility or the way staff treats them. Based on interviews conducted with staff and residents, the Department has insufficient evidence to support the allegation of “staff spoke inappropriately to resident”. Therefore, this allegation is deemed Unsubstantiated at this time.

It was also alleged that staff did not meet resident’s grooming needs and staff left resident in the same clothing for extended periods. It was reported that facility staff is not encouraging residents to brush their hair and teeth and R1 is always left in their nightgown. During the plant tour on 02/26/2025, the LPA observed five residents living at the facility, all of whom appeared to be well-groomed. Interviews conducted with residents revealed that staff assist with either showers or sponge baths 2 to 3 times a week.

Report Continued on LIC 9099C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250221163141
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SENIORS DIGNITY CARE
FACILITY NUMBER: 565850434
VISIT DATE: 03/20/2025
NARRATIVE
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Report Continued from LIC 9099C...

Residents stated that they have a set schedule for when they will receive a shower. Additionally, residents reported being changed every day. Furthermore, R1 stated that they have nightgowns, which were gifted to them, that they prefer to use daily. However, both staff and R1 stated that they ensure the nightgowns are kept clean, as they are rotated and washed every other day. Based on the information obtained, the Department has insufficient evidence to support the allegations of “staff did not meet resident’s grooming needs” and “staff left resident in the same clothing for extended periods”. Therefore, these allegations are deemed Unsubstantiated at this time.

It was further alleged that staff did not dispense medication to resident as prescribed. It was reported that facility staff is not giving R1 their pain medication which allows them to be more mobile. A review of R1’s medication list indicates that R1 was prescribed Acetaminophen (Tylenol) 500mg Oral Tablets, to take 2 tablets every 6 hours as needed for pain or fever. Additionally, a review of R1’s centrally stored medication and destruction record (CSMDR) revealed that Tylenol 500mg (100 tablets) was started on 01/13/2025. The medication review showed that R1 has been given 2 Tylenols twice a day since the start date. Interviews conducted with staff and residents confirmed this, as staff stated that R1 has been taking 2 Tylenols twice a day since it was prescribed, and R1 reported taking their pain medication every day, once in the morning and again in the evening. Furthermore, during interviews, residents stated that they receive their medication daily from staff and reported no concerns. Based on records reviewed and interviews conducted, the department has insufficient evidence to support the allegation of “staff did not dispense medication to resident as prescribed”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. Copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3