195850128-2-20-2024-29-AS-KHEN-D2WUF5-20240229143212

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850128
Report Date: 02/20/2024
Date Signed: 02/20/2024 05:10:46 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
12/02/2022 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20221202135058

FACILITY NAME:	NO HO RESIDENTIAL CARE, INC.		FACILITY NUMBER:	195850128
ADMINISTRATOR:	DURGARYAN, REBEKA		FACILITY TYPE:	740
ADDRESS:	6605 AGNES AVENUE		TELEPHONE:	(818) 404-0290
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 6	DATE:	02/20/2024
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Rebeka Durgaryan, Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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1. Facility staff did not dispense medications as prescribed.
2. Facility staff yelled at resident.
3. Facility staff did not treat resident with dignity
4, Facility staff did not safeguard resident's belongings
5. Facility staff did not allow resident to leave the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to conduct further investigation of the above allegations and was let into the home by Naira Aghajanyan, Staff. Rebeka Durgaryan, Administrator was contacted by staff and she arrived at 11:56am to conduct the visit.
The reason for today's visit was explained.

On 2/9/22, LPA Angel Ascencio conducted an initial unannounced complaint visit to investigate the above allegations and met with Naira Aghajanyan, staff since the Administrator could not attend. During the initial visit, LPA along with staff member conducted a physical plant tour, inside and outside, to ensure there are no safety hazards at 10:45 a.m., reviewed resident files at 11:15 a.m., and conducted resident interviews at 1:53 p.m. LPA Ascencio determined that further investigation is needed. LPA will return at a later time to conclude the investigation.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20221202135058

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: NO HO RESIDENTIAL CARE, INC.	FACILITY NUMBER: 195850128
	VISIT DATE: 02/20/2024

NARRATIVE

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On today's visit, LPA Yee reviewed all 6 resident files beginning at 12:01pm , reviewed resident medications at 1:30pm, interviewed the Administrator and Staff #1 together at 1:15pm. Residents were not interviewed on today's visit as the only resident who has lived at the facility since the facility opened in March 2021 has dementia and is a bad historian. All the other 5 residents have lived here since various dates in 2023 and 2024 and would not have knowledge of any residents who lived at the facility in 2022.

Per interview with the Administrator and Staff #1, regarding the above allegations, they remember a male LPA was here at the facility to investigate the complaint. When the LPA arrived at the facility he enquired about the facility's address and provided the name of the resident he was looking for that was specifically named in the complaint. The male LPA was told the facility's address and he was also told that they did not have any resident by the name he provided. They told him that he was at the wrong address because the LPA provided a completely different address for the home. Based on the initial complaint report generated on 2/9/22, the male LPA was identified as Angel Ascencio. LPA Ascensio conducted interviews with the residents and asked everyone how they were doing and if everything was okay. Residents and Staff #1 were asked if there were any thefts at the facility and was told that there were no thefts at the facility. Again, staff stated that they did not have any resident living at the facility with the name LPA Ascencio had provided to staff. LPA Ascencio apologized to the staff and left. Per the Administrator and Staff #1, they never received a copy of the initial complaint report.

Based on the information obtained, there was no evidence to support the allegations, therefore the above allegations are deemed unfounded at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

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