<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607890
Report Date: 04/18/2025
Date Signed: 04/18/2025 03:46:31 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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2025 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20250417081503
FACILITY NAME:BE WELL SENIOR LIVING INC.FACILITY NUMBER:
197607890
ADMINISTRATOR:RUSLAN MELNIKOVFACILITY TYPE:
740
ADDRESS:14739 MORRISON STREETTELEPHONE:
(818) 205-9313
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:6CENSUS: 6DATE:
04/18/2025
UNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Ruslan MelnikovTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not answer resident's call button in a timely manner
Staff do not ensure that the facility is maintained sanitary
Staff do not ensure resident's care needs are met
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Kelly Dulek and Quoc Huynh, along with Investigations Branch (IB) Investigator Michele Salant conducted an initial complaint investigation for the allegations listed above. LPAs and Investigator arrived at the facility at 09:16AM and initially met with facility staff. Administrator was contacted via telephone and arrived at 10:17AM. Entrance interview conducted.

During today's visit, LPAs toured the facility along with facility staff at 09:22AM, interviewed 3 (three) residents and 4 (four) staff at various times throughout the visit, interviewed Administrator at 10:17AM, reviewed and obtained copies of relevant documents, and conducted a medication review at 12:04PM. The following was then determined:

Allegations: "Staff do not respond to call button timely" and "Staff do not ensure resident's care needs are met:"
Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
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 5
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
04/17/2025 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20250417081503

FACILITY NAME:BE WELL SENIOR LIVING INC.FACILITY NUMBER:
197607890
ADMINISTRATOR:RUSLAN MELNIKOVFACILITY TYPE:
740
ADDRESS:14739 MORRISON STREETTELEPHONE:
(818) 205-9313
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:6CENSUS: 6DATE:
04/18/2025
UNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Ruslan MelnikovTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not distribute resident's medication as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Kelly Dulek and Quoc Huynh, along with Investigations Branch (IB) Investigator Michele Salant conducted an initial complaint investigation for the allegations listed above. LPAs and Investigator arrived at the facility at 09:16AM and initially met with facility staff. Administrator was contacted via telephone and arrived at 10:17AM. Entrance interview conducted.

During today's visit, LPAs toured the facility along with facility staff at 09:22AM, interviewed 3 (three) residents and 4 (four) staff at various times throughout the visit, interviewed Administrator at 10:17AM, reviewed and obtained copies of relevant documents, and conducted a medication review at 12:04PM. The following was then determined:

During the medication review, medications for 2 (two) residents were observed. Medications for both residents were documented appropriately on the centrally stored medication and destruction record (CSMDR),
Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20250417081503
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BE WELL SENIOR LIVING INC.
FACILITY NUMBER: 197607890
VISIT DATE: 04/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
all medications observed were labeled as required. No discrepancies were observed during the medication review. One resident (Resident #1 - R1) is able to store and administer their own prescription, over the counter and PRN (as needed) medications. Some of R1's medications were centrally stored and others were stored in R1's room. Residents and staff interviewed indicated medications are administered as prescribed. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

No citations issued related to the above allegation. Exit interview conducted. A copy of today's report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20250417081503
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: BE WELL SENIOR LIVING INC.
FACILITY NUMBER: 197607890
VISIT DATE: 04/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The complaint alleges that when residents request assistance, staff do not respond timely. Interviews with residents revealed that particularly during the night, staff do not respond to calls for assistance. Interview with Administrator revealed that the facility has 2 (two) care staff present from 07:00 or 08:00AM until 06:00PM. Between the hours of 06:00PM to 07:00 or 08:00AM, there is 1 (one) awake staff present at the facility. Personnel Report indicates 1 (one) awake staff scheduled from 07:00PM to 07:00AM 7 (seven) days a week. Staff and resident interviews revealed that during the night shift, staff take naps and are therefore not available to assist residents in meeting their needs. Most residents interviewed stated they have bells to use to request staff assistance, while other residents stated they just yell when requesting assistance. Residents reported slipping down from their bed and requesting assistance with medications during the night shift and staff did not respond. Staff interviewed indicated they do try to respond as quickly as possible when residents request assistance, but at times, they are busy assisting another resident and cannot respond timely. Based on interviews, the preponderance of evidence standard has been met, therefore the allegation is deemed SUBSTANTIATED at this time.

Allegation: "Facility staff do not ensure facility is maintained sanitary:"
During today's visit, LPAs and IB Investigator observed dirty/dusty vents throughout the facility, mold in the grout in the facility's common shower, sticky floor in the shared resident restroom, and dirt and mold were observed in the facility kitchen, both on the floor and around the kitchen sink. Although facility staff interviewed indicated there is a regular cleaning schedule, with cleaning tasks assigned daily, every other day or weekly, LPAs did not observe a cleaning log or any documentation of cleaning tasks completed. Additionally, LPAs and Investigator observed the lock on the knife drawer in the kitchen was broken and unable to be used. There were also broken toilet parts observed in the common facility restroom. Based on observation, the preponderance of evidence standard has been met, therefore the allegation is deemed SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies are cited (refer to LIC9099-D).

Exit interview conducted, appeal rights discussed, and a copy of this report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20250417081503
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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BE WELL SENIOR LIVING INC.
FACILITY NUMBER: 197607890
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/02/2025
Section Cited
CCR
87464(f)(1)
1
2
3
4
5
6
7
87464 Basic Services (f) Basic services shall at a minimum include:
(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c).
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator agreed to retrain night staff on facility policies and procedures related to call response times and appropriate break times. Proof of staff training will be provided to CCL by POC due date.
8
9
10
11
12
13
14
Based on interview and record review, the licensee did not comply with the above cited section, as residents stated staff sleep at night and are not available to assist when residents with their care needs, which poses a potential health and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
05/02/2025
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times... services and procedures for the safety and well-being of residents, employees and visitors.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator agreed to clean the identified areas of the faciilty and to fix both broken items. Proof of correction (photographs) will be sent to CCL by POC due date.
8
9
10
11
12
13
14
Based on observation, the licensee did not comply with the above cited section, as the facility bathroom was observed with mold and broken toilet parts, a broken lock in the kitchen, and dirty/dusty vents throughout the facility, which poses a potential health risk to residents in care.
8
9
10
11
12
13
14
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: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5