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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602348
Report Date: 01/31/2025
Date Signed: 01/31/2025 12:40:48 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/29/2025 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250129161244
FACILITY NAME:ST. ANNE'S GOLDEN YEARS HOMEFACILITY NUMBER:
197602348
ADMINISTRATOR:TIOPIANCO, MARIAFACILITY TYPE:
740
ADDRESS:5153 EAGLEROCK BOULVARDTELEPHONE:
(323) 550-1170
CITY:LOS ANGELESSTATE: CAZIP CODE:
90041
CAPACITY:6CENSUS: 5DATE:
01/31/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator, Maria Trillana and Licensee, Aurelio TrillanaTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff were not meeting residents toileting needs
Facility staff did not seek timely medical attention for residents fall
Facility staff pushed resident into bed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Antonia Alvizar-Ettima made an initial complaint visit to investigate the above noted allegations. LPA was greeted by Administrator, Licensee and explained the purpose of this visit.

At 11:30a.m. a physical plant tour was conducted. As a result of the investigation, LPA found that the resident (R1) in question never resided at this address. LPA reviewed facility residents roster and did not indicate that R1 is a former or current resident at this facility. The information revealed from records supported the information provided by the facility personnel. Therefore, the finding for the complaint allegations is UNFOUNDED. It was determined that the complaint was without a reasonable basis. Therefore, we dismissed the complaint.

No health and safety hazard is noted during this visit.
Exit interview was conducted and copy of report was issued.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
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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