Our Sweet Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Leslie Ngo-Castaneda and Huma Rahimi and Michael Cava conducted an Annual Required visit and inspection of the facility. LPAs met with the administrator, Tina Arutyunyan, and staff Norma Alfeche and Manual Soriiano and explained the reason for the visit. At approximately 12:46pm, with the assistance of staff, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are battery operated. The carbon monoxide detector, that is installed in the dining room, functions properly. The fire extinguisher is located in the kitchen. It was purchased on September 12, 2023. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were five (5) bedrooms designated for residents' use. Room #5 is a shared room. Rooms 1 to 4 are private. LPAs observed rooms that are occupied by the residents to be properly furnished with appropriate beddings and linens and sufficient lighting. Room #3 is currently vacant. There is one room, designated for staff use. Bathrooms: There are three (3) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 110 and 111 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were tested and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located by the living room. Detergents and cleaning supplies were kept locked. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were review for storage and documentation. documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were cited (refer to LIC 809-D). Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, Sep 28, 2023

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Michael Cava conducted Case Management (CM) visit and inspection of the facility to insure facility compliance. On May 27, 2022, a Non Compliance Conference (NCC) was held at the Woodland Hills Regional office. As a result of that NCC, the facility was placed on a three year compliance plan. LPA met with staff, Arlene Aragon and Manuel Soriano and explained the reason for the visit. At approximately 10:45am, with the assistance of staff, LPA took a tour of the physical plant. The smoke alarms are hardwired. The carbon monoxide detector is installed in the dining room. The fire extinguisher is located in the kitchen. It is brand new. The purchase date is August 4, 2022. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. LPA did not observe any sharps or knives out in the open. They were properly stored and locked in a cabinet. Properly labeled medications were locked in one of the kitchen cabinets, along with the medication, staff and resident records. Bedrooms: There were six (6) bedrooms designated for residents' use. Five (5) bedrooms are private amd one (1) is shared. All the bedrooms were properly furnished with appropriate beddings, linens and sufficient lighting. Bathrooms: There are three (3) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 105 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. There was enough space to hold outdoor activities for the residents in care. The laundry area is located by the living room. Cleaning supplies are stored and maintained locked there. Residents are not allowed to enter the laundry area. Medications: Medication and Medication Records were reviewed for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the day's visit. Exit Interview Conducted and a Copy of this report was issued.the state’s words, verbatim · CDSS document, Mar 17, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Patrick Shanahan, arrived at the facility in order to conduct an infection control annual. The LPA was greeted by a facility staff, who was observed not to be wearing a mask. The LPA entered the home and was not screen per the covid-19 protocol. LPA also observed a visitor at the facility who was also not screened prior to being allowed entry. LPA toured the facility and observed in room number 3 a resident with a full bed rail. The administrator did not have a prescription for the bed rail during the visit. A tour of the kitchen also revealed that the facility did not have a sufficient amount of perishable food for the residents in care. At about 2:10 PM, groceries were observed to be delivered to the home and a copy of the receipt was emailed to LPA. The smoke alarm and the carbon monoxide detectors were tested, and functioned properly. The fire extinguisher was last serviced on 8/23/21 and was functional. The LPA was also able to go through the cash recourses for one resident and the amounts appeared to add up and no discrepancies were observed. Exit interview conducted, deficiencies cited and report issuedthe state’s words, verbatim · CDSS document, Aug 22, 2022

Type of visit: POC

Licensing Program Analysts (LPAs) Tuesday Cabiness and Joselyn Martinez conducted a POC visit and met with Administrator Tina Arutyunyan who was informed the reason of the visit. The reason of today's visit, was to clear the citations/deficiencies that were issued during the office meeting on 04/26/2022. The Administrator submitted the POC's when they were due on 05/10/2022, and LPA re-reviewed and discussed with the Administrator the documents and cleared the citations. Administrator informed LPA, that the new banking account that was opened, will be used for P&I purposes only, and was opened under the corporation of Our Sweet Home. LPA reviewed the banking document, in which the amount for R1 for Our Sweet Home Inc was deposited. According to the Administrator, because the account is new, she has to wait for the first banking statement, which will be issued in (30) days. Once the Administrator has the statement, she will submit a new LIC405, (Record of Client/Resident's Safeguarded Cash Resources) form for resident # 1 & 2 (R1 & R2), showing the amount of money that is owed for R1 & R2. The Administrator will ensure, that R1 is aware of the balance, with a date and signature from R1 & R2 and the Administrator. The Administrator will submit a copy of the new P&I log for R1 & R2, attached with the banking statement to LPA. Administrator informed LPA that R1 & R2 is able to handle R1's own finances, and she will no longer be responsible for R1 & R2 personal expenses. Administrator also stated, that she will not keep petty cash at the facility, since both residents will be given the money monthly. LPA also received the Administrator's statement that was required, regarding how moving forward, P&I will be disbursed for R1 R2. LPA will follow up with Administrator within the next couple of weeks, for the bank statement and the signed P&I log for R1 R2. Exit interview conducted.the state’s words, verbatim · CDSS document, May 17, 2022

Allegation investigated: Financial Abuse

A Scheduled Office Meeting was held at the Monterey Park Adult and Senior Care (CCLD) Regional Office to deliver findings on the above allegation. The purpose of the meeting was explained to Licensee Tina Arutyunyan. The attendees present during the meeting were: CCLD Regional Manager (RM) Aracely Ramirez, , Licensing Program Managers (LPMs)Lisa Hicks, Stefanie Coronel, Naira Margaryan, Licensing Program Analysts (LPAs) Yelena Avetisyan; Tuesday Cabiness, Rosaura Valenzuela, Naomi Galarza, Mary Flores and Audit Manager Jacqueline Juarez. Regarding the allegation, It was reported that Licensee/Administrator financially abused residents by misappropriating the Personal & Incidental (P&I) funds of two (2) residents (R1 & R2), who are enrolled in the LA County Department of Health Services [Housing for Help] Enriched Residential Care (ERC) program, which contracts a non-profit organization called Brilliant Corners. The Department of Health Services places persons in licensed facilities. Brilliant Corners is the payee and is responsible for making payment for recipients of their program who are usually homeless, do not qualify for Social Security benefits, and are provided wrap-around services by Brilliant Corners. Substantiated On June 2, 2021, the Department of Health Services conducted a random Quality Assurance audit visit, and it was noted that personal and incidental monies were not documented or accounted appropriately. Licensee/Administrator Tina Arutyunyan was informed of the deficiency and submitted hand-written receipts on the Plan of Correction documents. The items listed are missing resident’s initials/signatures and original receipts to support transactions. Department of health observed that the documents were prepared after the fact, as they were dated with 8/11/2021 as a plan of correction. An initial 10-day complaint visit was conducted on 09/01/2021 by Licensing Program Analysts (LPA's) Yelena Avetisyan, Calvin Tsui and Licensing Program Manager (LPM) Eva Miller at which time interviews were held with residents and records reviewed. Also during the visit Tina Arutyunyan was asked via telephone to submit the following documents: Bank Records from past and current accounts for January 2019 to Present. 2. P&I logs for all residents who receive assistance with their finances and 3. Verification of a Valid and Current Surety Bond. The requested records were emailed to the LPA on 9/1/2021 and 9/2/2022 by Licensee/Administrator Tina Arutyunyan. Records reviewed revealed that licensee was not documenting the residents P&I funds. When Copies of P&I logs were requested the licensee/administrator submitted handwritten receipts without resident signatures and attached receipts. The handwritten receipts submitted for Resident 1 (R1) and Resident 2 (R2) documented excess expenditures for foods and charges for foreign language cable channel which the licensee was paying for prior to R1 and R2 being admitted to the facility. Additionally, the submitted receipts documented charges for special food, grooming items, grooming services. and clothing which R1 and R2 denied receiving and representatives did not observe at the facility during the initial 10 day complaint visit. On 9/20/2021 A Trust Audit Referral was made to Community Care Licensing Division’s Audit Department and assigned to Jacqueline Juarez, Audit Manager who investigated the following: Licensee/Administrator Misappropriated residents personal & incidental (P&I) funds, Licensee/Administrator did not maintain adequate safeguards and records for residents cash resources and Licensee/Administrator comingled the residents personal and incidental funds with facility funds. The trust Audit was completed on 3/7/2022. During the course of the investigation Auditor Juarez conducted interviews with Program Manager for the Quality Assurance Enriched Residential Program with the County of Los Angeles and discussed their audit of residents placed at the facility and clarify how payments are issued to the facility. Interviews were also conducted with Representatives from Brilliant Corners to inquire about their program and involvement with the residents, the Licensee/Administrator Tina Arutyunyan. Auditor also conducted review of all documents submitted to the Department related to the complaint. The information obtained from the interviews conducted revealed that the licensee is issued monthly lump sum payments for the residents who are recipients of their program. The Agreement which is signed by the Licensee/Administrator and Brilliant Corners staff specifies how the amounts should be allocated (Rent, Personal and Incidental expenses, Enhanced Services). The Audit investigation concluded that the Licensee/Administrator Misappropriated residents personal & incidental (P&I) funds, failed to maintain adequate safeguards and records for residents cash resources and Comingled the residents personal and incidental funds with facility funds. Additionally the Department investigation revealed that the licensee/administrator did not comply with licensing requirements specific to Safeguards for Residents Cash, Personal Property and Valuables and requirements for obtaining a surety bond prior to handling residents cash resources. Additionally, the licensee/administrator provided Department of Health Services and Community Care Licensing inaccurate information/documentation. Based on the information obtained the Allegation of Financial Abuse is Substantiated at this time. During the visit Licensee/Administrator was notified that she will need to complete the following: · Refund all residents of Brilliant Corners the amounts identified in the report and submit proof of repayment. · Provide proof of adequate bonds for each facility. · Submit a written plan on how they will distribute P&I funds to residents and bank statements showing the P&I funds have been deposited in a trust account. On 10/05/2022 Licensee/Administrator will need to submit to the Audit Section the LIC 405’s and corresponding receipts for each facility to ensure proper record keeping. Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 9099-D). Exit Interview Conducted /Appeal Rights Discussed and Copy of Report emailed.the state’s words, verbatim · CDSS document, Apr 26, 2022 · control 31-AS-20210824091525

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: May 10, 2022

Safeguards for Resident Cash, Personal Property, and Valuables. (b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources This requirement is not met as evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by not retaining receipts for items purchased with residents P&I which posed a personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: The Licensee will refund P&I funds to two (02) residents of Brilliant Corners as described in Audit report and furnish Regional Office and Brilliant Corners proof of repayment. The documents must be provided to CCLD by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(c)(1) · Plan of correction due date: May 10, 2022

(c) Every facility shall account for any cash resources entrusted to the care or control of the licensee or facility staff. (1) Cash resources include but are not limited to monetary gifts, tax credits and/or refunds, earnings from employment or workshops, and personal and incidental need allowances from funding sources such as SSI/SSP. This requirement is not met as evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by not distributing P & I funds to residents (R1 & R2), and not keeping proper records of funds entrusted to her which posed a personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee agrees to: 1. Pay back residents (R1 & R2) all P & I amounts due. Licensee owes: Resident (R1) $1242.00 Resident (R2) $966.00 2. Submit proof (bank statements) that the amounts due were issued to R1 & R2.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(e) · Plan of correction due date: May 10, 2022

(e) Cash resources and valuables of residents which are handled by the licensee for safekeeping shall not be commingled with or used as the facility funds or petty cash, and shall be separate, intact and free from any liability the licensee incurs in the use of his own or the facility's funds and valuables. This requirement was not met evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by commingling facility funds with personal and incidental funds. This posed/poses a personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee/administrator agrees to open a bank trust account for the residents P&I and deposit residents' P & I funds into the trust account only. Facility bank account should not have any residents' P&I monies. Provide copies of bank statements showing P & I funds have been deposited into a trust account.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87216(a) · Plan of correction due date: May 10, 2022

(a) Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file, or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. The amount of the bond shall be in accordance with the schedule listed under this regulation. This requirement was not met evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by acknowledging that a surety Bond was not in place prior to this complaint investigation which poses a health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee agrees to Obtain and submit a copy of the Surety Bond for each facility by POC due date. NOTE: The Surety Bond should cover the facility, and not the corporation.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87207 · Plan of correction due date: Apr 29, 2022

False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by providing inaccurate information and documentation to Department of Health Services and Community Care Licensingthe state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee/Administrator will schedule vendorized training related to the cited section as well as 87408: Denial or Revocation of a Certificate 87777: Exclusions Personal Rights. Verification of scheduled training with the trainers credentials will need to e submitted by 4/29/2022 and completed by 5/13/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(2-3)(5) · Plan of correction due date: May 13, 2022

The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. (3) Ability to maintain or supervise the maintenance of financial and other records (5) Good character and a continuing reputation of personal integrity. This requirement was not evidenced by: Based record review and interview conducted during the audit investigation the Licensee failed to maintain accurate financial records; and provided DHS and CCL inaccurate documentation and information.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee/Administrator will schedule vendorized training related to the cited section as well as all other sections cited on this report Verification of scheduled training with the trainers credentials will need to e submitted by 4/29/2022 and completed by 5/13/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87215 · Plan of correction due date: May 10, 2022

Money and valuables of residents entrusted to the licensee of one community care facility licensed under a particular license number shall not be commingled with those of another residential care facility for the elderly of a different license number, regardless of joint ownership. This requirement was not met evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by commingling facility funds with personal and incidental funds. Licensee misappropriated residents personal and incidental (P &) funds. which posed a health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee agrees to provide a copy of the bank statement showing P & I funds have been deposited into a trust account. Submit by POC due date.

Type of visit: Office

An office meeting was held at the Monterey Park Adult and Senior Care Regional Office (MP ASCRO) to deliver the Final Findings of a Trust Audit Report involving the following facilities: Skyhill Quality Living #2 197609098: [Complaint Investigation - Control #:31-AS-20210824091525], Skyhill Quality Living 197608910, Our Sweet Home Inc 197607711, Our Sweet Home Inc #2 197608083, and Our Sweet Home Inc #3 197608084, Attendees present during the meeting were: Licensee/Administrator Tina Arutyunyan and Administrator/Assistant Administrator Akop Ekimyan. CCLD Regional Manager Aracely Ramirez, CCLD Audit Department Manager, Jacqueline Juarez, Licensing Program Manager(s) Lisa Hicks, Naira Margaryan, Stefanie Coronel, and Licensing Program Analyst(s) Noemi Galarza, Mary Flores, Yelena Avetisyan, Tuesday Cabiness, and Rosaura Valenzuela. The purpose of the meeting was explained to Licensee Ms. Arutyunyan and Mr. Ekimyan . On 08/24/2021 Community Care Licensing Division (CCLD) received complaints against all above noted facilities operated by the same Licensee. The complainant was alleging financial abuse of the residents' Personal and Incidental (P&I) funds. An initial investigation visit was conducted on 09/01/2021. As a part of the complaint investigation, the complaints were referred to the CCLD Audit Department for a Trust Audit. The audit investigation conducted by Jacqueline Juarez concluded the following: The Licensee/Administrator Misappropriated residents Personal and Incidental (P&I) funds. Multiple residents did not have access to, or were not distributed P&I funds. The Licensee/Administrator failed to maintain adequate safeguards and records for residents' cash resources. Proper documentation for expenditures was not maintained. The Licensee/Administrator Commingled the residents P&I monies with facility funds. On today's date, CCLD Audit Manager Jacqueline Juarez delivered findings on the Trust Audit Report and discussed required plan of corrections (POCs). The Licensee/Administrator was notified that she will need to complete the following: Refund all residents' enrolled in the Brilliant Corners program the amounts identified in the Trust Audit report and submit proof of repayment. Provide proof of Surety Bond that covers each facility license and not the corporation. Submit a written plan on how they will distribute P&I funds to residents and bank statements showing that P&I funds have been deposited in a separate trust account. Submit an updated Plan of Operation reflecting the changes in population that will be served. On 10/5/2022, Licensee/Administrator is to submit to the Audit Section the LIC 405's and corresponding receipts for each facility to ensure proper record-keeping. The deficiencies related to the complaint allegation were also discussed during today's Office meeting, and were disclosed in the final complaint investigation report delivered to the Licensee Ms. Arutyunyan. See complaint control number 28-AS-20210824090807. During the initial complaint investigation visit dated (9/1/2021) resident's files were reviewed. Based on record review observation, LPA observed the resident files were incomplete and/or missing required forms i.e. personal and incidental (P & I) records, original receipts, hospice care plans, and admission agreements were missing authorized representative parties contact information. In addition, copies of the LIC 500 Personnel Report, resident roster were not obtained or available at the facility. Licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Update all facility admission agreements to include contact information for all residents’ representative parties. A discussion was held with Ms. Arutyunyan regarding observations made during the initial 10 day complaint visit at this facility. Ms. Arutyunyan was informed that a follow up visit will be conducted at a later date to address the deficiencies. A discussion was also held regarding the staff room that was not previously identified in the facility sketch. Per Ms. Arutyunyan and Mr. Ekimyan the staff room is permitted. LPA requested and Ms. Arutyunyan agreed to submit copies of the permits to LPA on or before 5/10/2022. The Licensee was offered and agreed to receive assistance from the Departments Technical Support Program. A brochure was provided to Ms. Arutyunyan and Mr. Ekimyan during the office meeting. Per Title 22 Regulations, Division 6 Chapter 8, Article 09, a deficiency was cited. See LIC 809D. An exit interview was conducted and a copy of this report and appeal rights was issued to Licensee Tina Arutyunyan.the state’s words, verbatim · CDSS document, Apr 26, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Apr 29, 2022

Resident Records. The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met evidenced by: Based on record review observations during the visit dated 9/1/21) in reference to complaint # 31-AS-20210824091525, residents' files were incomplete and/or missing required forms. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee/Administrator will review Title 22 regulations section 87506(b)(1-17) as a guide to ensure compliance with the regulation. Licensee/administrator will review update/complete all residents records including hospice records for the hospice residents. Once the files have been updated/completed licensee administrator will submit a written notidication to the department confirming that the resident files are all updated and completed

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility 9:00 to conduct an unannounced infection control inspection/visit. Upon arriving, LPA was greeted by caregiver Rodolfo Tripon; who allowed LPA to enter the facility. According to Rodolfo, there have not been any active or past COVID cases at the facility, and all staff and residents have been vaccinated. The current census is (6). LPA's temperature was taken, and LPA observed the .cleaning table, with hand sanitizer at the front door. LPA observed both staff to have full mask covering. COVID-19, CDC, Department of Public Health, and Licensing postings on the walls throughout the facility. Rodolfo contacted Administrator Tina Arutyunyan, LPA spoke to over the facility telephone. Administrator could not be present during the visit, due to being out of town. The infection control inspection began with the caregiver Rodolfo, who escorted LPA throughout the facility. The facility has (6) bedrooms; with (1) room for staff, and (1) shared room. The common areas were observed to be clean, including bathrooms, with soap and towels, and hand washing signs visually posted. LPA conducted a mitigation plan review with the caregiver Rodolfo, in order to obtain information on how the facility has implemented the department's mitigation plan; who could only provide limited information pertaining to COVID procedures. The facility has documentation of all vaccination records and other pertinent information pertaining to COVID-19. Visitation is allowed, in certain areas of the facility, and everyone is screened prior to entry. Residents do not wear masks inside the facility; only when they leave. Residents eat together in the dining room, and they continue to social distance. LPA discussed with the caregiver, that even though, everyone in the facility has been vaccinated, safety measures should continue to be implemented. LPA could not obtain personnel issues, such as staffing and sick leave policies, since Administrator was not available. PPE, cleaning, and other related supplies were inspected. The facility continues to implement the best practices for their facility; which has kept them COVID-19 free. The facility is aware to report any changes with residents and staff to Licensing and there LPA, pertaining to positive COVID-19 cases. Exit interview was conducted with caregiver Rodolfo, and copy of report will be emailed to Administrator.the state’s words, verbatim · CDSS document, Aug 6, 2021

Allegation investigated: Staff caused multiple fractures to resident Staff Interacted with resident in an inappropriate manner

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to deliver the findings of the above allegations. LPA met with staff Connie Gayahan who called the administrator Tina Arutyunyan and designated her to sign the report. LPA explained the reason for the visit. Entrance interview conducted. On 01/28/2020, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was initiated by the LPA Michael Cava and completed by the Investigator Peter Zertuche from the Investigation Branch of Community Care Licensing Division. During course of investigation, on 01/29/2020 at 9:00 AM, LPA Cava interviewed facility staff, including the staff attending Resident #1 (R1), administrator, and residents. Investigator Zertuche interviewed residents and staff on 01/30/2020. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) In addition, Investigator interviewed R1’s responsible party on 02/11//2020, Reporting Party (RP) on 02/12/2020 and R1 on 02/13/2020. On 01/29/20, LPA Cava obtained copies of the facility records and on 01/30/2020, Investigator Zertuche obtained hospital medical records. 1. Regarding the allegation that staff caused multiple fracture to residents, it was alleged that the staff cause the fractures on R1's hands and feet. LPA’s interview with the staff revealed that on 01/24/2020 R1 had an unwitnessed fall in their bedroom. Staff heard R1’s scream and immediately went to assist. R1 denied any pain at that time. The next day, on 01/25/2020, Home Health nurse visited and recommended R1 be brought to the hospital due to complaint of pain. LPA’s record review on 01/29/2020 verified the information revealed from the staff interview. Records also indicated that R1’s scream was overheard by another resident who saw the staff entering the room, while R1 was on the floor. Investigator Zertuche’s and LPA Cava’s interview with staff and residents on different dates and different occasion, consistently revealed that no one witnessed nor had any knowledge of any staff hurt or attempted to hurt R1 or any other resident in any way. Investigator Zertuche’s interview with the R1’s responsible party revealed that R1 had a history of falsely accusing the facility staff. 2. Regarding the allegation that staff interacted with resident in an inappropriate manner, it was reported that staff handles R1 inappropriately. (continued on LIC 9099-C) (continued from LIC 9099-C) LPA Cava’s interview with three (3) residents at the facility on 01/29/20 revealed that no staff had been inappropriate with them nor they witnessed any staff being inappropriate with any other resident. IB Investigator Zertuche’s interview with four (4) residents on 01/30/2020 also revealed that they had no complaints regarding the staff and that they treat them well. Based on information gathered during the course of the investigation, the allegations are deemed unsubstantiated at this time Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jul 23, 2021 · control 31-AS-20200128132406