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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 195850128
Report Date: 03/28/2023
Date Signed: 03/28/2023 04:53:23 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
11/29/2021 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20211129153412
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:
03/28/2023
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Rebeka DurgaryanTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff do not ensure residents are properly fed while in care
INVESTIGATION FINDINGS:
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A subsequent complaint visit was conducted today to deliver above allegation finding. Upon arrival Licensing Program Analyst (LPA) met with staff and later with Administrator Rebeka Durgaryan. During todays visit LPA met with staff at approximately 2:20PM and conducted a physical plant tour. Facility had sufficient food supply during todays visit. At approximately 3:45PM LPA conducted interview with Administrator and explained reason for the visit.

Following is a summary of the investigation:

On 12/08/2021, an initial complaint inspection was conducted by LPA Saila Walker - the LPA conducted a physical plant tour at approximately 3:51PM; From 3:55PM to 4:08PM, the LPA conducted interviews with two (2) out of six (6) residents. From 4:10PM to 4:26PM, the LPA conducted an interview with administrator. From 4:29PM to 4:33PM, the LPA conducted interviews with one (1) out of two (2) staff. (LIC9099c)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
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-20211129153412
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: 03/28/2023
NARRATIVE
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On 12/28/2021, a subsequent visit was conducted by LPAs Salia Walker and Elsie Campos - LPAs conducted a physical plant tour at 2:15PM. From 2:18PM to 2:22PM, the LPAs conducted an interview with one (1) out of six (6) residents. From 2:49PM to 3:04PM, the LPAs conducted an interview with the administrator. From 3:04PM to 3:35PM, LPAs reviewed and obtained copies of documents.

Records reviewed by LPA Walker revealed that former resident (R1) was admitted to the facility on 11/25/2021 upon discharge from hospital. R1 started declining rapidly once at the facility and therefore was placed on comfort care (24 hours) by ABC Hospice. R1 was eventually not taking any food or liquids per hospice plan. R1 lived at the facility for only two weeks (11/25/2021 - 12/09/2021). R1 passed away at this facility with hospice present on 12/10/2021.

During the initial and subsequent visit to this home three (3) out (6) residents interviewed did not have any issues with food service. During todays visit (03/28/2023) LPA observed residents eating and enjoying there meals. Based on observation, interviews conducted and records reviewed there is insufficient evidence to support the allegation "Staff do not ensure residents are properly fed while in care". Therefore the allegation is Unsubstantiated at this time.

Exit interview conducted. A copy of the report provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2