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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603936
Report Date: 12/02/2021
Date Signed: 12/02/2021 11:11:55 AM

Unfounded


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
12/01/2021 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 29-AS-20211201155733
FACILITY NAME:JUST LIKE HOMEFACILITY NUMBER:
197603936
ADMINISTRATOR:ALEXSANDRA VARTAPETOVAFACILITY TYPE:
740
ADDRESS:12521 KILLION STREETTELEPHONE:
(818) 769-9955
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:6CENSUS: 5DATE:
12/02/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:ALEXSANDRA VARTAPETOVATIME COMPLETED:
11:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained pressure injuries while in care.
Facility did not seek timely medical treatment for changes in resident's health.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/2/2021, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day complaint investigation visit regarding the above allegations. LPA Urena arrived at the facility at 9:45 a.m., and spoke on the phone with the Administrator Alexsandra Vartapetova, and explained the purpose of the visit.
At 10:00am, LPA Urena conducted file review for six residents. At 10:15 a.m. LPA Urena interviewed staff.

On the allegations: Resident sustained pressure injuries while in care, and Facility did not seek timely medical treatment for changes in resident's health. Based on observation, records review, and staff interviews, the Resident was never admitted at this facility, therefore this allegation is found to be Unfounded at this time.

No deficiencies cited. Exit interview conducted with Administrator Alexsandra Vartapetove. Signatures obtained. A copy of report was issued.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
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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