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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850128
Report Date: 07/16/2021
Date Signed: 07/16/2021 10:59:13 AM

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
07/12/2021 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20210712112759
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: 4DATE:
07/16/2021
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Rebeka DurgaryanTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Facility does not provide a safe environment for residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced at 9:10 a.m. to conduct an initial complaint visit. The LPA met with Administrator Rebeka Durgaryan and explained the reason for the visit.

During today's visit, the LPA conducted a tour, reviewed files at 9:30 a.m., interviewed staff at 9:49 a.m., interviewed residents from 9:59 a.m. - 10:10.am, and, interviewed a family member of a resident at 10:15a.m.

Regarding the allegation, it was alleged that the facility was creating an unsafe environment, as residents were allegedly given access to lighters to smoke cigarettes. There was a concern that allowing a resident access to a lighter could create an unsafe environment, especially for residents whom use oxygen. During today's visit, the LPA observed a designated smoking area in the front and the back of the house. Observations confirmed that the designated smoking area(s) are over fifteen (15) feet from any window or entryway into the home.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
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 2
Control Number 29-AS-20210712112759
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: 07/16/2021
NARRATIVE
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 The LPA reviewed files at 9:30 a.m., and confirmed that facility house rules state that smoking may only take place in designated areas. At the time of the visit, there was only one resident (R1) identified as someone who smokes. At 9:55 a.m, the LPA observed that lighters were kept locked in a locked box in the kitchen drawer.

The LPA interviewed R1, who confirmed that they only smoke in designated areas in the facility, and denied ever smoking inside the facility. R1 claims to not have smoked in the presence of any resident whom was on oxygen. R1 did not have their lighter and noted that it was locked up. In addition, the LPA interviewed a family member of another resident who was present during today's visit, and they confirmed that they have not observed anyone smoking either inside or outside of the facility. This particular family member visits this facility at least twice a day.

During today's visit, the LPA observed appropriate 'No Smoking - Oxygen in Use' signs for those residents whom use oxygen. The Administrator confirmed that R1 occasionally smokes, and confirmed that they only allow R1 to smoke in designated areas.

Based on the information obtained, there is insufficient evidence to support the claim that the facility does not provide a safe environment for residents in care. The facility has a house rule that addresses a policy around smoking in designated outdoor areas and lighters are locked up for the safety of all residents. The designated smoking areas are an appropriate distance from the facility. This allegation is Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2