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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850128
Report Date: 01/03/2022
Date Signed: 01/03/2022 04:19:14 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
12/31/2021 and conducted by Evaluator Salia Walker
COMPLAINT CONTROL NUMBER: 29-AS-20211231141147
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:
01/03/2022
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Naira AghajanyanTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff are prohibiting resident to move from the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for an initial complaint inspection for the above allegation. The LPA met with Naira Aghajanyan at 9:56 a.m., and explained the reason for the visit.

During today’s visit, the LPA conducted a physical plant tour at 11:18 a.m., to ensure there are no health and safety hazards. From 10:01 a.m. until 10:20 a.m., the LPA conducted interviews with one (1) staff. From 10:20 a.m. until 10:38 a.m., the LPA conducted an interview with the administrator. From 10:39 a.m. until 11:18 a.m., the LPA conducted interviews with facility residents. From 11:28 a.m. until 11:49 a.m., the LPA conducted a record reviewed and obtained copies of documents pertinent to the investigation. From 12:21 p.m. until 1:11 p.m., the LPA conducted an interview with resident family member(s).
Regarding the allegation, ‘Staff are prohibiting resident to move from the facility,’ the complainant’s concern is that the facility is prohibiting resident #1 (R1) from moving out of the facility, and is keeping R1 against R1’s will.
Continue on LIC9099C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
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
12/31/2021 and conducted by Evaluator Salia Walker
COMPLAINT CONTROL NUMBER: 29-AS-20211231141147

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:
01/03/2022
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Naira AghajanyanTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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9
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 an initial complaint inspection for the above allegations. The LPA met with Naira Aghajanyan at 9:56 a.m., and explained the reason for the visit.
During today’s visit, the LPA conducted a physical plant tour at 11:18 a.m., to ensure there are no health and safety hazards. From 10:01 a.m. until 10:20 a.m., the LPA conducted interviews with one (1) staff. From 10:20 a.m. until 10:38 a.m., the LPA conducted an interview with the administrator. From 10:39 a.m. until 11:18 a.m., the LPA conducted interviews with facility residents. From 11:28 a.m. until 11:49 a.m., the LPA conducted a record reviewed and obtained copies of documents pertinent to the investigation. From 12:21 p.m. until 1:11 p.m., the LPA conducted an interview with resident family member(s).
Regarding the allegation, ‘Staff is unable to communicate effectively with the residents while in care,’ the complainant’s concern is that facility staff are unable to effectively communicate with the residents in English. As a result, there is concern that resident needs are not being met.
Continue on LIC9099C..
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
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-20211231141147
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: 01/03/2022
NARRATIVE
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During the investigation, the LPA conducted interviews with facility staff, the administrator, facility residents, and resident family member(s) which revealed that they believe that there is a language barrier which prohibits staff from communicating effectively with the residents. LPA Walker asked staff #1 (S1) multiple questions regarding care and supervision such as, ‘What would you do if you observed a resident having a heart attack’; ‘Do you know how to call the paramedics’; and ‘What would you do if you observed a resident having a seizure.’ S1’s responses were not consistent with the LPAs questions. When the LPA interviewed the administrator, the administrator denied the allegation. The Administrator stated that staff are able to communicate effectively with all of the residents. The Administrator also stated that staff are utilizing Apps, and books to learn Basic English. When the LPA asked the administrator to instruct S1 to show the App that staff is using to learn English, the administrator stated that S1 did not have it on this phone due to recently switching phones. Interviews with facility residents, and resident family members revealed that they believe ‘It would be good to have a caregiver there that is fluent in English.’ Interviews also revealed that ‘sometimes [staff] don’t understand well’ when residents are asking questions they ‘give [a] blank stare.’

Based on interviews with staff, the administrator, facility residents, and resident family member(s), there is sufficient evidence to support the allegation ‘Staff is unable to communicate effectively with the residents while in care.’ Therefore, the above allegation is found to be Substantiated. The facility was previously cited for the same allegation on 09/14/2021 under section 87411(a). Additionally, civil penalties are being assessed for a repeat violation.

Pursuant to Title 22 Division 6 Chapter 8 of the California Code of Regulations, the following deficiency was cited (refer to LIC 9099D). Civil Penalties assessed for Repeat Violation. Exit interview conducted, and appeal rights discussed. A copy of the report, and appeal rights were issued.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20211231141147
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: 01/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/07/2022
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.Submit proof of staff training to communicate with residents through the use of communication boards.
2.Submit proof of staff’s translating devices and apps, for basic English.
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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: 01/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20211231141147
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: 01/03/2022
NARRATIVE
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During the investigation, LPA Walker conducted a record review, interviews with staff, the administrator, facility residents, and resident family member(s). Interviews revealed that It has been proven that R1 not able to care for themselves in their own home. It was reported that upon entry of R1’s home the refrigerator was full of rotten food, overflowing sink with dirty dishes, and the house was unkept. Interviews also revealed that R1 has gone on outing with family, and is not being locked in the facility by any means. Record review revealed that R1 requires supervision, and is not able to leave the facility unassisted due to history of altered mental status.
Based on LPAs observation, record review, and interviews conducted. Although, R1 is requesting to move from the facility, given the circumstances R1’s family and medical professionals have highly recommended that R1 remains in a facility providing care and supervision. Based on LPAs observation, R1 is able to go outside to the facility’s front porch, and backyard at any time.
Therefore, there is insufficient evidence to support the allegation ‘Staff are prohibiting resident to move from the facility.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Salia Walker
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5