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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608083
Report Date: 04/26/2022
Date Signed: 04/26/2022 12:58:29 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
08/23/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210823141159
FACILITY NAME:OUR SWEET HOME INC #2FACILITY NUMBER:
197608083
ADMINISTRATOR:ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:10150 MELVIN AVETELEPHONE:
(818) 970-9586
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 5DATE:
04/26/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tina Arutyunyan & Akop EkimyanTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility is financially abusing resident
INVESTIGATION FINDINGS:
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An in-person office meeting was conducted at the Monterey Park Adult and Senior Care Regional Office (MP ASCRO). A Regional Manager (RM) Araceli Ramirez, Manager of Audit Department Jacqueline Juarez, Licensing Program Analysts (LPAs) Tuesday Cabiness, Rosaura Valenzuela, Yelena Avetisyan, and Licensing Program Manager (LPM) Naira Margaryan from the Woodland Hills South Adult and Senior Care Regional Office (WHS ASCRO), LPAs Mary Flores and Noemi Galarza, LPMs Lisa Hicks, Stefanie Coronel from Monterey Park ASCO and Licensee/Administrator Tina Arutyunyan, with Administrator Akop Ekimyan were present at the time of this meeting; and was informed the reason of the meeting.

On August 23, 2021, the Woodland Hills Adult and Senior Care office received a complaint alleging facility was financially abusing resident #1 (R1), by retaining R1’s personal and
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
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 7
Control Number 31-AS-20210823141159
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 #2
FACILITY NUMBER: 197608083
VISIT DATE: 04/26/2022
NARRATIVE
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incidental funds (P&I). It was also alleged that, R1 was requesting specific items, and the Administrator/Licensee was billing Department of Health Services (DHS) for items R1 was
requesting. R1 revealed the items were never requested or received, although the items were billed to DHS. On September 01, 2021, from 10am to 1pm, LPA Wendell Smith initiated the investigation, and conducted interviews with resident #1 (R1) and resident # 2 (R2). LPA Smith also requested various records to be reviewed. The Administrator/Licensee Tina Arutyunyan was contacted telephonically, in which, specific documents were requested: bank records from January 2019 to present; P&I records for all residents who received assistance with their finances, and verification of a valid and current surety bond.

According to records received and reviewed, it was determined, that the Administrator/Licensee did not have a valid or current surety bond to handle residents P&I funds. In lieu of the P&I records, the Administrator/Licensee submitted hand-written receipts without residents’ signatures and attached receipts for expenditures. The handwritten receipts submitted, documented an excessive and inflated number of expenditures for special food, charges for cable channels, grooming items/services, clothing, and furniture. Residents interviewed during the initial complaint visit, denied receiving those items and LPA Wendell Smith did not observe described clothing and furniture in the facility. It was determined the Licensee/Administrator misappropriated residents personal & incidental (P&I) funds and did not maintain adequate financial records or expenses for residents’ cash resources. The Licensee/Administrator co-mingled the residents’ (P&I) funds with facility funds, without obtaining a surety bond to handle residents’ cash resources.

On September 20, 2021, the complaint was referred to Community Care Licensing Division (CCLD) audit department for further review of the Administrator/Licensee trust and financial accounts. The complaint was assigned to auditor manager Jacqueline Juarez, who reviewed and completed an audit investigation. Auditor Juarez conducted interviews with the County of Los Angeles, Department of Health Services, Housing for Health-Enriched Residential Care Program, and a representative from Brilliant Corners. The auditor obtained information pertaining to the placement of residents to the facility; the programs and their involvement with the residents; the issuance of payments for residents, and the relationship with the
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
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 7
Control Number 31-AS-20210823141159
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 #2
FACILITY NUMBER: 197608083
VISIT DATE: 04/26/2022
NARRATIVE
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Administrator/Licensee. The auditor also reviewed all documents and information obtained by the Regional Office in relation to the complaint. It was revealed, the Administrator/Licensee is issued a monthly lump sum payment for the residents enrolled with Brilliant Corners. There
was a signed agreement between the Administrator/Licensee and a Brilliant Corner representative. The agreement specified how the payments for the residents should be allocated for their expenses, such as (rent, personal incidentals, and enhanced services).

On March 08, 2022, 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. Overall, the investigation revealed that the Administrator/Licensee did not comply with Licensing requirements and regulations, pertaining Safeguards for Residents Cash Resources, Personal Property and Valuables. The Administrator/Licensee also did not obtain a surety bond prior to handling residents’ cash resources. Additionally, the Administrator/Licensee provided Brilliant Corners and DHS inaccurate and inflated expenses of expenditures for R1.

Based on the information obtained, the allegation of financial abuse is Substantiated at this time. Citations and deficiencies were discussed with the Licensee/Administrator. Exit interview, appeal rights, and a copy of report was issued.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
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 7
Control Number 31-AS-20210823141159
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 #2
FACILITY NUMBER: 197608083
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
87216(a)
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Bonding: (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
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The Licensee will obtain a required surety bond. A proof of adequate bond will be submitted to CCL BY POC due date
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company to the State of California as principal.

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Request Denied
Type B
05/10/2022
Section Cited
CCR
87215
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Commingling of Money: 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 for another
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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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residential care facility for the elderly of a different license number, regardless of joint ownership.
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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: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
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: 4 of 7
Control Number 31-AS-20210823141159
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 #2
FACILITY NUMBER: 197608083
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 (1) 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
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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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CCLD by POC due date.
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 p
ersonal and incidental need allowances from funding sources such as SSI/SSP.
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Licensee agrees to: 1. Pay back residents (R1) P & I amounts due. Licensee owes: Resident (R1) $3,159; Submit proof (bank statements) that the amounts due were issued to R1.
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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), 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: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
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 7
Control Number 31-AS-20210823141159
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 #2
FACILITY NUMBER: 197608083
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.
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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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Provide copies of bank statements showing P & I funds have been deposited into a trust account.
Request Denied
Type B
05/10/2022
Section Cited
CCR
87405(d)(2-3)(d)
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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: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
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 7
Control Number 31-AS-20210823141159
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 #2
FACILITY NUMBER: 197608083
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
04/27/2022
Section Cited
HSC
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
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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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CCR
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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: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
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 7