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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850128
Report Date: 05/21/2021
Date Signed: 05/21/2021 05:32:01 PM

Substantiated


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
05/17/2021 and conducted by Evaluator Kasandra Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20210517145549
FACILITY NAME:NO HO RESIDENTIAL CARE, INC.FACILITY NUMBER:
195850128
ADMINISTRATOR:DURGARYAN, REBEKAFACILITY TYPE:
740
ADDRESS:6605 AGNES AVENUETELEPHONE:
(818) 404-0290
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 6DATE:
05/21/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Rebeka DurgaryanTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff is not repositioning Resident #1 (R1) as needed
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) KaSandra Lopez and Salia Walker conducted an unannounced initial 10 day Complaint inspection. When the LPAs arrived there were six residents and one staff present. Administrator Rebeka Durgaryan arrived at approximately 10:12 AM.

Beginning at 9:50 AM the LPAs began a physical plant tour. At 10:00 AM the facilities food supply was observed. Between at 10:12 AM and 11:20 AM, interviews were conducted with Resident #1 (R1), Resident #2 (R2), Resident#3 (R3), and Resident #4 (R4). Through out the inspection and at 12:00 PM interviews were conducted with Administrator Rebeka Durgaryan. The LPAs left the facility at 12:30 PM and returned at 3:30 PM to continue the investigation.

The allegation alleges R1 whom is bedridden is not being repositioned regularly. Interviews with R1 revealed R1 is unable to reposition on their own and staff are not being repositioning R1.
Report continued LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
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 5
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
05/17/2021 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20210517145549

FACILITY NAME:NO HO RESIDENTIAL CARE, INC.FACILITY NUMBER:
195850128
ADMINISTRATOR:DURGARYAN, REBEKAFACILITY TYPE:
740
ADDRESS:6605 AGNES AVENUETELEPHONE:
(818) 404-0290
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:6CENSUS: 6DATE:
05/21/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Rebeka DurgaryanTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff not feeding resident an adequate amount of meals.
Staff handling resident in an inappropriate manner.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) KaSandra Lopez and Salia Walker conducted an unannounced initial complaint inspection. When the LPAs arrived there were six residents and one staff present. Administrator Rebeka Durgaryan arrived at approximately 10:12 AM.

Beginning at 9:50 AM the LPAs began a physical plant tour. At 10:00 AM the facilities food supply was observed. Between at 10:12 AM and 11:20 AM, interviews were conducted with Resident #1 (R1), Resident #2 (R2), Resident#3 (R3),and Resident #4 (R4). Through out the inspection and at 12:00 PM interviews were conducted with Administrator Rebeka Durgaryan.

A review of the facility food supply found there is a sufficient supply of perishable and non-perishable food. Interviews with three of out four residents revealed they received an adequate amount of food at each meal and received three meals a day. Based on this information the allegation is found to be unsubstantiated.
Report continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20210517145549
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: NO HO RESIDENTIAL CARE, INC.
FACILITY NUMBER: 195850128
VISIT DATE: 05/21/2021
NARRATIVE
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The allegation of "Staff handling resident in an inappropriate manner" alleges staff are aggressive when changing Resident #1 (R1). Interviews with R1 revealed that staff did not handle them properly when assisting R1. Interviews with the administrator revealed there are no complaints of staff handling R1 in an aggressive matter. The other residents interviewed in the home had no complaints regarding how they are being treated by staff. Based on the information obtained during the investigation, the allegation is found to be unsubstantiated.

Exit interview conducted. A copy of the report will be emailed to the administrator by the end of the day.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20210517145549
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: NO HO RESIDENTIAL CARE, INC.
FACILITY NUMBER: 195850128
VISIT DATE: 05/21/2021
NARRATIVE
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During the interview with Administrator Rebeka Durgaryan, she stated R1 is a two person assist for repositioning. Ms. Durgaryan stated they are repositioning R1 every two-three hours but there is no record of this being done. Also when the LPAs arrived there was only one staff present to assist R1. Review of the facility staff schedule revealed two staff are to be on shift during the day. Record review also revealed no proof staff has received training in repositioning.

Based on the information obtained during the inspection, there is sufficient evidence support the allegation of "Staff is not repositioning Resident #1 (R1) as needed" occurred. Therefore, the allegation is substantiated. The following deficiency was observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20210517145549
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: NO HO RESIDENTIAL CARE, INC.
FACILITY NUMBER: 195850128
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2021
Section Cited
CCR
87468.1
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirement is not met as evidenced by:
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The licensee shall submit proof there will be two staff on duty at all times to assist R1. The licensee shall also submit proof that staff received training for repositioning by an outside vendor and staff are repositioning R1 every 2-3 hours or as needed.

The plan of correction shall be submitted by 5/24/21 to the Woodland Hill Regional Office.
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Based on interviews and record review, the licensee did not comply with the section cited above as R1 is a two person assist and only one staff was at the facility when the LPAs arrived which poses an immediate health and safety risk to R1 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.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5