195850298-2-7-2025-29-AS-KLOZ-DG8VGL-20250430162540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 195850298
Report Date: 02/07/2025
Date Signed: 02/07/2025 04:20:20 PM

Unsubstantiated

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
01/17/2025 and conducted by Evaluator Trevor Byrne

COMPLAINT CONTROL NUMBER: 29-AS-20250117154733

FACILITY NAME:	LAURELGROVE BOARD AND CARE		FACILITY NUMBER:	195850298
ADMINISTRATOR:	TADEVOSYAN, LUSINE		FACILITY TYPE:	740
ADDRESS:	8221 LAURELGROVE AVE		TELEPHONE:	(818) 355-2632
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 6	DATE:	02/07/2025
		UNANNOUNCED	TIME BEGAN:	01:57 PM
MET WITH:	Dianna Karapetyan		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not safeguard a resident's personal belongings
Staff refused a resident access to the facility's telephone
Staff did not ensure food the resident was eating was safe for consumption

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced follow-up complaint investigation visit at the facility at 01:57 PM. LPA met with facility staff who contacted the Administrator Dianna Karapetyan. The Administrator arrived to the facility at approximately 02:10 PM the reason for the visit was explained and entrance interview was conducted.

During the initial complaint visit on 01/22/2025 LPA conducted a physical plant tour to ensure there are no health and safety hazards, collected copies of pertinent documents, and conducted interviews with the Administrator, one (1) staff member, and three (3) residents between 09:30 AM. and 11:20 AM. During today’s visit LPA conducted a brief physical plant tour, Interviewed one (1) staff member, two (2) witnesses, and one (1) resident.

Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

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-20250117154733

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: LAURELGROVE BOARD AND CARE	FACILITY NUMBER: 195850298
	VISIT DATE: 02/07/2025

NARRATIVE

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The allegation of “Staff did not safeguard a resident's personal belongings” alleges that facility staff took three (3) packages of cigarettes from resident #1’s (R1) possession. An interview with R1 revealed that they had a bag containing 10 packages of Lucky Strike Cigarettes. R1 stated that Staff #1 (S1) had taken the bag containing the packages of cigarettes from their possession. R1 stated that that facility staff returned the bag the same evening but the bag only contained seven (7) packages of cigarettes upon receipt. Interviews with facility staff members and other facility residents revealed that no other members of the facility are smokers. No other residents interviewed have had personal items taken by staff and no residents interviewed have been denied access to their personal belongings. S1 denied taking any packages of cigarettes from R1’s bag. LPA confirmed with staff and R1 that due to the care needs of the other residents residing at the facility cigarettes would need to be stored inaccessible to the other residents in care. CCR 87309(c) states, “Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents.” Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not safeguard a resident's personal belongings.” Therefore, the allegation is deemed Unsubstantiated at this time.

The allegation of “Staff refused a resident access to the facility's telephone” alleges that facility staff denied R1 access to the facility’s telephone during the evening that R1’s cigarette bag was taken from them. During an interview with Witness #1 (W1) they initially stated that they remembered the evening where R1 had their cigarettes taken. W1 initially informed LPA that they recalled speaking with R1 that evening and described R1 as “Hysterical” W1 stated that R1 was upset that they couldn’t go outside to smoke. Interviews with other residents of the facility did not reveal any concerns regarding access to the facility phone. All staff interviewed denied ever forbidding residents access to the facility’s phone. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff refused a resident access to the facility's telephone.” Therefore, the allegation is deemed Unsubstantiated at this time.

Continued on LIC 9099C.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250117154733

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: LAURELGROVE BOARD AND CARE	FACILITY NUMBER: 195850298
	VISIT DATE: 02/07/2025

NARRATIVE

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The allegation of “Staff did not ensure food the resident was eating was safe for consumption” alleges that the facility is poisoning R1 with arsenic laced food. During the physical plant tour LPA observed the facility’s refrigerators and freezers to be maintained at appropriate temperatures. LPA did not observe any chemicals stored in food preparation areas. LPA did not observe any poisons located on the facility’s premises. Interviews with other residents did not reveal any concerns with the quality of the food being served at the facility. All staff members interviewed denied adding harmful substances to any resident’s food. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not ensure food the resident was eating was safe for consumption.” Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview was conducted. This report was reviewed with the Administrator and a copy was provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

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