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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607711
Report Date: 04/26/2022
Date Signed: 04/26/2022 12:51:43 PM

Substantiated


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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2021 and conducted by Evaluator Yelena Avetisyan
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210824091525
FACILITY NAME:OUR SWEET HOME INCFACILITY NUMBER:
197607711
ADMINISTRATOR:ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:16518 DEVONSHIRE STTELEPHONE:
(818) 970-9586
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 4DATE:
04/26/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tina Arutyunyan and Hakop EkimyanTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Financial Abuse
INVESTIGATION FINDINGS:
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A Scheduled Office Meeting was held at the Monterey Park Adult and Senior Care (CCLD) Regional Office to deliver findings on the above allegation. The purpose of the meeting was explained to Licensee Tina Arutyunyan. The attendees present during the meeting were: CCLD Regional Manager (RM) Aracely Ramirez, , Licensing Program Managers (LPMs)Lisa Hicks, Stefanie Coronel, Naira Margaryan, Licensing Program Analysts (LPAs) Yelena Avetisyan; Tuesday Cabiness, Rosaura Valenzuela, Naomi Galarza, Mary Flores and Audit Manager Jacqueline Juarez.

Regarding the allegation, It was reported that Licensee/Administrator financially abused residents by misappropriating the Personal & Incidental (P&I) funds of two (2) residents (R1 & R2), who are enrolled in the LA County Department of Health Services [Housing for Help] Enriched Residential Care (ERC) program, which contracts a non-profit organization called Brilliant Corners. The Department of Health Services places persons in licensed facilities. Brilliant Corners is the payee and is responsible for making payment for recipients of their program who are usually homeless, do not qualify for Social Security benefits, and are provided wrap-around services by Brilliant Corners.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
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 8
Control Number 31-AS-20210824091525
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
VISIT DATE: 04/26/2022
NARRATIVE
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On June 2, 2021, the Department of Health Services conducted a random Quality Assurance audit visit, and it was noted that personal and incidental monies were not documented or accounted appropriately. Licensee/Administrator Tina Arutyunyan was informed of the deficiency and submitted hand-written receipts on the Plan of Correction documents. The items listed are missing resident’s initials/signatures and original receipts to support transactions. Department of health observed that the documents were prepared after the fact, as they were dated with 8/11/2021 as a plan of correction.

An initial 10-day complaint visit was conducted on 09/01/2021 by Licensing Program Analysts (LPA's) Yelena Avetisyan, Calvin Tsui and Licensing Program Manager (LPM) Eva Miller at which time interviews were held with residents and records reviewed. Also during the visit Tina Arutyunyan was asked via telephone to submit the following documents: Bank Records from past and current accounts for January 2019 to Present. 2. P&I logs for all residents who receive assistance with their finances and 3. Verification of a Valid and Current Surety Bond. The requested records were emailed to the LPA on 9/1/2021 and 9/2/2022 by Licensee/Administrator Tina Arutyunyan.

Records reviewed revealed that licensee was not documenting the residents P&I funds. When Copies of P&I logs were requested the licensee/administrator submitted handwritten receipts without resident signatures and attached receipts. The handwritten receipts submitted for Resident 1 (R1) and Resident 2 (R2) documented excess expenditures for foods and charges for foreign language cable channel which the licensee was paying for prior to R1 and R2 being admitted to the facility. Additionally, the submitted receipts documented charges for special food, grooming items, grooming services. and clothing which R1 and R2 denied receiving and representatives did not observe at the facility during the initial 10 day complaint visit.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 31-AS-20210824091525
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
VISIT DATE: 04/26/2022
NARRATIVE
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On 9/20/2021 A Trust Audit Referral was made to Community Care Licensing Division’s Audit Department and assigned to Jacqueline Juarez, Audit Manager who investigated the following: Licensee/Administrator Misappropriated residents personal & incidental (P&I) funds, Licensee/Administrator did not maintain adequate safeguards and records for residents cash resources and Licensee/Administrator comingled the residents personal and incidental funds with facility funds. The trust Audit was completed on 3/7/2022.

During the course of the investigation Auditor Juarez conducted interviews with Program Manager for the Quality Assurance Enriched Residential Program with the County of Los Angeles and discussed their audit of residents placed at the facility and clarify how payments are issued to the facility. Interviews were also conducted with Representatives from Brilliant Corners to inquire about their program and involvement with the residents, the Licensee/Administrator Tina Arutyunyan. Auditor also conducted review of all documents submitted to the Department related to the complaint.



The information obtained from the interviews conducted revealed that the licensee is issued monthly lump sum payments for the residents who are recipients of their program. The Agreement which is signed by the Licensee/Administrator and Brilliant Corners staff specifies how the amounts should be allocated (Rent, Personal and Incidental expenses, Enhanced Services).

The Audit investigation concluded that the Licensee/Administrator Misappropriated residents personal & incidental (P&I) funds, failed to maintain adequate safeguards and records for residents cash resources and Comingled the residents personal and incidental funds with facility funds. Additionally the Department investigation revealed that the licensee/administrator did not comply with licensing requirements specific to Safeguards for Residents Cash, Personal Property

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 31-AS-20210824091525
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
VISIT DATE: 04/26/2022
NARRATIVE
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and Valuables and requirements for obtaining a surety bond prior to handling residents cash resources. Additionally, the licensee/administrator provided Department of Health Services and Community Care Licensing inaccurate information/documentation. Based on the information obtained the Allegation of Financial Abuse is Substantiated at this time.

During the visit Licensee/Administrator was notified that she will need to complete the following:

· Refund all residents of Brilliant Corners the amounts identified in the report and submit proof of repayment.

· Provide proof of adequate bonds for each facility.

· Submit a written plan on how they will distribute P&I funds to residents and bank statements showing the P&I funds have been deposited in a trust account.

On 10/05/2022 Licensee/Administrator will need to submit to the Audit Section the LIC 405’s and corresponding receipts for each facility to ensure proper record keeping.

Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 9099-D). Exit Interview Conducted /Appeal Rights Discussed and Copy of Report emailed.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 31-AS-20210824091525
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/10/2022
Section Cited
CCR
87217(b)
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Safeguards for Resident Cash, Personal Property, and Valuables. (b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources
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The Licensee will refund P&I funds to two (02) residents of Brilliant Corners as described in Audit report and furnish Regional Office and Brilliant Corners proof of repayment. The documents must be provided to CCLD by POC due date.
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This requirement is not met as evidenced by:
Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by not retaining receipts for items purchased with residents P&I which posed a personal rights violation to residents in care.
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Request Denied
Type B
05/10/2022
Section Cited
CCR
87217(c)(1)
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(c) Every facility shall account for any cash resources entrusted to the care or control of the licensee or facility staff. (1) Cash resources include but are not limited to monetary gifts, tax credits and/or refunds, earnings from employment or workshops, and personal and incidental need allowances from funding sources such as SSI/SSP.
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Licensee agrees to:
1. Pay back residents (R1 & R2) all P & I amounts due. Licensee owes:
Resident (R1) $1242.00
Resident (R2) $966.00
2. Submit proof (bank statements) that the amounts due were issued to R1 & R2.
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This requirement is not met as evidenced by:
Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by not distributing P & I funds to residents (R1 & R2), and not keeping proper records of funds entrusted to her which posed a personal rights violation to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 31-AS-20210824091525
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/10/2022
Section Cited
CCR
87217(e)
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(e) Cash resources and valuables of residents which are handled by the licensee for safekeeping shall not be commingled with or used as the facility funds or petty cash, and shall be separate, intact and free from any liability the licensee incurs in the use of his own or the facility's funds and valuables.
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Licensee/administrator agrees to open a bank trust account for the residents P&I and deposit residents' P & I funds into the trust account only. Facility bank account should not have any residents' P&I monies. Provide copies of bank statements showing P & I funds have been deposited into a trust account.
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This requirement was not met evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by commingling facility funds with personal and incidental funds. This posed/poses a personal rights risk to persons in care.
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Request Denied
Type B
05/10/2022
Section Cited
CCR
87216(a)
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(a) Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file, or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. The amount of the bond shall be in accordance with the schedule listed under this regulation.
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Licensee agrees to Obtain and submit a copy of the Surety Bond for each facility by POC due date.

NOTE: The Surety Bond should cover the facility, and not the corporation.
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This requirement was not met evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by acknowledging that a surety Bond was not in place prior to this complaint investigation which poses a health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 31-AS-20210824091525
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/29/2022
Section Cited
CCR
87207
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False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.
This requirement was not evidenced by:
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Licensee/Administrator will schedule vendorized training related to the cited section as well as
87408: Denial or Revocation of a Certificate
87777: Exclusions
Personal Rights.
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Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by providing inaccurate information and documentation to Department of Health Services and Community Care Licensing
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Verification of scheduled training with the trainers credentials will need to e submitted by 4/29/2022 and completed by 5/13/2022.
Request Denied
Type B
05/13/2022
Section Cited
CCR
87405(d)(2-3)(5)
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The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. (3) Ability to maintain or supervise the maintenance of financial and other records
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Licensee/Administrator will schedule vendorized training related to the cited section as well as all other sections cited on this report
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(5) Good character and a continuing reputation of personal integrity. This requirement was not evidenced by: Based record review and interview conducted during the audit investigation the Licensee failed to maintain accurate financial records; and provided DHS and CCL inaccurate documentation and information.
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Verification of scheduled training with the trainers credentials will need to e submitted by 4/29/2022 and completed by 5/13/2022.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 31-AS-20210824091525
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: OUR SWEET HOME INC
FACILITY NUMBER: 197607711
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/10/2022
Section Cited
CCR
87215
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Money and valuables of residents entrusted to the licensee of one community care facility licensed under a particular license number shall not be commingled with those of another residential care facility for the elderly of a different license number, regardless of joint ownership. This requirement was not met evidenced by: Based on record review
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Licensee agrees to provide a copy of the bank statement showing P & I funds have been deposited into a trust account.

Submit by POC due date.
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and interview conducted during the audit investigation the licensee did not comply with the cited section by commingling facility funds with personal and incidental funds. Licensee misappropriated residents personal and incidental (P &) funds. which posed a health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC9099 (FAS) - (06/04)
Page: 8 of 8