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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850128
Report Date: 09/14/2021
Date Signed: 09/14/2021 10:45:32 AM

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
06/28/2021 and conducted by Evaluator Salia Walker
COMPLAINT CONTROL NUMBER: 29-AS-20210628101044
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: 5DATE:
09/14/2021
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Rebeka Durgaryan, AdministratorTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Staff is unable to communicate effectively with the residents while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint visit to deliver the investigation finding for the above allegation. The LPA met with Administrator Rebeka Durgaryan at 08:34 a.m. and explained the reason for the visit.
During today’s visit, the LPA conducted a physical plant tour at 08:29 a.m., and conducted an interview with staff #1 (S1).
On 07/02/21, LPAs Walker and Balisi conducted an initial complaint visit. Between 9:00 a.m. and 12:00 p.m., the LPAs conducted a physical plant tour, interviewed residents, administrator, as well as reviewed and obtained copies of documents pertinent to the investigation. The LPAs determined, at that time, that further investigation was required.

Continued on LIC 9099C..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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 4
Control Number 29-AS-20210628101044
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: 09/14/2021
NARRATIVE
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Regarding the allegation, ‘Staff is unable to communicate effectively with the residents while in care’, the complainant’s concern is that the two (2) facility staff are unable to effectively communicate with the residents and/or visitors in English. As a result, there is concern that resident needs are not being met.
During the investigation, the LPAs conducted interviews with the facility residents which revealed that they believe that there is a language barrier which prohibits staff from communicating effectively with the residents. It was stated that staff only understand basic needs in English.
When the LPAs interviewed the administrator, the administrator denied the allegation. The Administrator stated that staff are able to communicate effectively with all of the residents. The LPAs asked the administrator if staff have ever called the administrator to translate for them. The Administrator stated that this has never happened. The Administrator also stated that staff and residents are always able to communicate with one another.
On 06/30/21, a record review revealed that outside agency credible witness have visited the facility and during these visits, the collateral agencies also had difficulty communicating with staff. The records review revealed that they believe that there is a language barrier which prohibits staff from communicating effectively with the residents and outside agencies. It was stated that at times, the staff have to contact the administrator for translation.
On 07/15/21, LPA Walker received additional information, which references caregivers whom were unable to speak English. A record review of this additional information revealed that the facility has not maintained consistent English-speaking staff.
The LPAs conducted visits on June 3, 2021, July 2, 2021 and on July 16, 2021. During those visits, the LPAs have only observed staff #1 to be working at the facility. The LPAs have never witnessed staff #2 present in the facility. Staff #1 was unable to effectively communicate with residents, outside agencies and the LPAs.
During today’s interview, LPA Walker asked staff #1 several questions such as, ‘Does any resident have dietary needs’; ‘How often are residents checked’; ‘In case of an emergency, who would you contact’; ‘What would you do if you observed a resident having a heart attack’; ‘What would you do if you observed a resident fall’; ‘Do you know how to call the paramedics’; and ‘What would you do if you observed a resident having a seizure’. Staff #1 did not appear to understand any of the LPA’s questions and stated ‘no understand, and I don’t know’.

Continued on LIC 9099C..
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20210628101044
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: 09/14/2021
NARRATIVE
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Based on the record review, outside agency creditable witness, interviews with staff, residents, and the administrator, there is sufficient evidence to support the allegation ‘Staff is unable to communicate effectively with the residents while in care.’
Therefore, the allegation, ‘staff is unable to communicate effectively with the residents while in care’ is deemed Substantiated at this time.

Deficiencies cited on 9099-D
Exit interview conducted, a copy of the report and appeal rights were provided.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20210628101044
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: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2021
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements – General: Facility personnel shall at all times be.. competent to provide the services necessary to meet resident needs.. facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by:
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The Licensee has agreed to do the following:
1.The Licensee will document a plan of action, ensuring that the staff can communicate effectively and thus meeting the needs of the residents. This plan of action will be submitted to the LPA by 09/21/21.
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Based on interviews and documents reviewed, the Licensee did not comply with the section cited above, as the Licensee failed to ensure that staff are able to communicate effectively with the residents while in care, which poses a potential health and safety risk to residents 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: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4