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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607711
Report Date: 08/28/2024
Date Signed: 08/28/2024 02:39:53 PM

Unsubstantiated


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
07/23/2024 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20240723091150
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: 5DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Tina ArutyunyanTIME COMPLETED:
11:06 AM
ALLEGATION(S):
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Resident sustained injuries while in care due to lack of care and supervision
Facility did not report incident(s) as required.
Staff did not meet resident's hygiene needs.
Staff did not properly dispose of soiled incontinence products
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. LPA met with the administrator, Tina Arutyunyan, and advised her of the complaint. LPA Cava's investigation consisted of interviews with staff and residents, a physical plant inspection, and record review.

Resident sustained injuries while in care due to lack of care and supervision/Facility did not report incident(s) as required:
In regards to the allegation, it was reported that Resident 1 (R1) had wandered day and night, while at the facility, and experienced falls due to lack of getting their medicaitons. R1 did not get their medicine until approximately eight days after admission. As a result of these falls, R1 sustained bruising to the arms, legs, hips and head. Moreover, R1's falls and injury was not reported to licensing and their responsible party. Interviews with the administrator and two (2) of two staff deny both allegations. Interviews with administrator
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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 3
Control Number 31-AS-20240723091150
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: 08/28/2024
NARRATIVE
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and staff reveal that R1 only lived in the facility for approximately two months. Within that two months, R1 only had one confirmed fall. Staff and administrator confirmed that the fall happened sometime in July 2023. Staff 1 (S1) was present during R1's fall, which they went to assist R1 immediately after a loud sound coming from R1's room made. S1 assessed R1, and only observed small bruising. Administrator, R1's hospice agency, and family were all notified. Medical attention and first aid was applied. LPA conducted a record review, and observed that an incident report was completed and submitted July 10, 2023. Regarding R1's medications, administrator stated R1 had medication with them at admission, when they were discharged from the skilled nursing where R1 was previously residing. As soon as hospice was initiated, prescriptions refills were made and filled. Administrator assured there were no lapse in medications. LPA also conducted a review of R1's medication records and did not observe any lapse. Based on the information obtained, it could not be proven that R1's injuries were caused due to lack of care and supervision, and facility failed to report an incident as required. Therefore, allegations are deemed Unsubstantiated at this time.

Staff did not meet resident's hygiene needs:
In regards to the allegation, it was reported that R1 was not given proper nutrition, bathing and showers. R1 was only sprayed with deodorant in perfume. Review of R1's files does indicate assistance with bathing. Interviews with the administrator and two (2) of two staff reveal that R1's hospice nurse would come to the facility twice a week to provide R1 with bathing/shower service. In addition to the bathing and showering, staff would give R1 a bed/sponge bath in between the hospice visits. Interviews made with six (6) of six residents reveal no complaints about their hygiene needs not being met. Review of R1's hospice care plan, and interview with hospice nurse confirm that bathing was part of the care plan, and that it was made twice a week. Based on the information obtained, there wasn't enough evidence to prove that staff did not meet R1's hygiene needs. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff did not properly dispose of soiled incontinence products:
In regards to the allegation, it was reported that facility bathrooms and outside patio are never clean. Dirty diapers aren't disposed of properly. Interviews with (2) of two staff both confirm that facility bathrooms are cleaned everyday. Staff state they insure soiled diapers are disposed of, and bathrooms are checked on
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20240723091150
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: 08/28/2024
NARRATIVE
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often in the day to insure it is maintained and clean. Interviews made with six (6) of six residents have no complaints of the bathrooms not being maintained and clean. In conjunction with today's investigation, LPA conducted an annual visit and inspection of the physical plant. The facility has three (3) bathroom, which were observed clean during the day's visit. Based on the information obtained, there wasn't enough evidence to confirm that staff do not properly dispose of soiled incontinent products. Therefore, the allegation is deemed Unsubstantiated at this time. Administrator advised and a copy of this report given.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3