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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608084
Report Date: 04/26/2022
Date Signed: 04/26/2022 05:07:44 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 Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20210824093316
FACILITY NAME:OUR SWEET HOME INC #3FACILITY NUMBER:
197608084
ADMINISTRATOR:ARUTYUNYAN, TINAFACILITY TYPE:
740
ADDRESS:21054 VINTAGE STTELEPHONE:
(818) 960-5224
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:6CENSUS: 5DATE:
04/26/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tina Arutyunyan and Akop Ekimyun- Licensee RepresentativeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Financial Abuse.
INVESTIGATION FINDINGS:
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An Office Meeting was held at the Monterey Park Adult and Senior Care Regional Office (MP ASCRO). The attendees present during the meeting were: CCLD Regional Manager Aracely Ramirez, A manager of the Audit Department Jacqueline Juarez, Licensing Program Manager (LPM) Naira Margaryan and Licensing Program Analysts (LPAs) Rosaura Valenzuela, Yelena Avetisyan and Tuesday Cabiness from Woodland Hills South Adult and Senior Care Regional Office (WH ASCRO), LPM's Lisa Hicks and Stephanie Coronel, LPAs Mary Flores and Noemi Galarza from MP ASCRO.

At the time of this Office Visit a final finding of the investigation report was delivered to the Licensee Representatives Tina Arutyunyan and Akop Ekimyan by LPA Rosaura Valenzuela.

On 08/23/2021, Community Care Licensing Department (CCLD) received a complaint alleging that the Licensee/Administrator was financially abusing the residents in care by retaining their Personal and Incidental funds (P&I).
Continue on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
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 6
Control Number 31-AS-20210824093316
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 #3
FACILITY NUMBER: 197608084
VISIT DATE: 04/26/2022
NARRATIVE
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An initial 10-day complaint visit was conducted on 08/24/2021 by Licensing Program Analysts (LPAs) Patrick Shanahan and Nicholas Reed at which time interviews were held with four (04) out of six (06) residents and various records were requested for review. The Licensee/Administrator was contracted telephonically, and LPAs requested to submit the following documents:
1. 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.
3. Verification of a Valid and Current Surety Bond.

A review of records received revealed that licensee was not insured and bonded to handle residents P&I funds. In lieu of P&I logs, the Licensee/Administrator submitted hand-written receipts without residents' signatures and attached receipts for expenditures. The handwritten receipts submitted for the residents documented excess expenditures for special foods, charges for cable channels, grooming items, grooming services, clothing and furniture. Residents interviewed during the 10-day complaint visit denied receiving those items and LPAs did not observe described clothing and furniture in the facility.

On 09/20/2021, the complaint was referred to CCLD Audit Department for a Trust Audit and was assigned to Jacqueline Juarez, Audit Manager who investigated the following: Licensee/Administrator Misappropriated residents personal and incidental (P&I) funds. Licensee/Administrator did not maintain adequate safeguards and records for residents cash resources. Licensee/Administrator commingled the residents personal and incidental funds with facility funds. Licensee/Administrator handled residents cash resources prior to obtaining required surety bond.

While conducting financial auditing pertaining to the allegation of financial abuse, Auditor Juarez conducted interviews with the Program Manager for the Quality Assurance Enriched Residential Program with the County of Los Angeles and with the representative of Brilliant Corners and discussed the audit of residents placed at the facility and to clarify how the payments are issued to the facility. Auditor inquired information regarding the programs and their involvement with the residents and the Licensee/Administrator Tina Arutyunyan. Auditor also conducted a review of all documents submitted to the Department relevant to the complaint.

Continue on 9099-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
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 6
Control Number 31-AS-20210824093316
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 #3
FACILITY NUMBER: 197608084
VISIT DATE: 04/26/2022
NARRATIVE
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Per information revealed from the interviews conducted by the auditor, the licensee was issued monthly lump sum payments for the residents enrolled in Brilliant Corners. The Agreement which was signed by the Licensee/Administrator and Brilliant Corners staff specifies how the amounts should be allocated (Rent,
Personal and Incidental expenses, Enhanced Services).

On 03/08/2022 an Audit investigation concluded that the Licensee/Administrator Misappropriated residents personal and incidental (P&I) funds, failed to maintain adequate safeguards and records for residents' cash resources and Commingled the residents personal and incidental funds with facility funds. Overall. the investigation revealed that the licensee/administrator did not comply with licensing requirements regarding a Safeguards for Residents Cash Resources, Personal Property and Valuables and failed to obtain a surety bond prior to handling residents cash resources. Additionally, the Licensee/Administrator provided Brilliant Corners and the Licensing Department inaccurate information/documentation.

Based on the information obtained the Allegation of Financial Abuse is SUBSTANTIATED at this time.

At the time of this visit the following deficiencies were cited and recorded on LIC 9099Ds. Exit interview was held, appeal rights were discussed, and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
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 6
Control Number 31-AS-20210824093316
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 #3
FACILITY NUMBER: 197608084
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 values 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 four (04) 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:

The licensee did not ensure to provide receipts for items purchased by using residents P&I funds. This poses a potential 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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Safeguards for Resident Cash, Personal Property, and Valuables. (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 will implement policies and procedures regarding residents' cash resources and valuables. Copies of the policies and procedures will be provided to CCL by POC due date.
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This requirement is not met as evidenced by: Licensee did not ensure to be accountable for residents' cash resources. P&I funds were not safeguarded as required.

This poses a potential 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: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
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 6
Control Number 31-AS-20210824093316
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 #3
FACILITY NUMBER: 197608084
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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Safeguards for Resident Cash, Personal Property, and Valuables. (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 will open a separate trust account for resident P&I funds. A document regarding a new bank account will be submitted to CCL by POC due date.
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This requirement is not met as evidenced by:

The Licensee did not ensure to separate residents' cash resources from facility finds.

This poses a potential personal rights violation to residents in care.
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Request Denied
Type B
05/10/2022
Section Cited
CCR
87216(a)
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Bonding. (a) Each licensee, other that 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.

This requirement is not met as evidenced by:
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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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Licensee dud not obtain required surety bonds prior to handling residents cash resources.

This poses a potential 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: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
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 6
Control Number 31-AS-20210824093316
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 #3
FACILITY NUMBER: 197608084
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
CCR
87405(d)(1-7)(3)
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Administrator-Qualifications and Duties (d) 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. (3) Ability to maintain or supervise the maintain or supervise the maintenance of financial and other records.
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Licensee will attend continued education classes provided for Administrators. By POC due date, the Licensee will secure the appointment to attend the classes and inform CCL about the attendance. The Licensee must register for the class by tomorrow.
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This requirement is not met as evidenced by:

Licensee/Administrator did not ensure to maintain accurate financial records.

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Request Denied
Type A
04/27/2022
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 is not met as evidenced by:
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Licensee will provide a written statement explaining how they will ensure that, moving forward, no false statements or misleading information will be provided regarding the facility and the services provided by the facility. ,This written statement must be submitted by close of business day on 4/27/2022.
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The licensee did not ensure to provide accurate information and records to the LPAs and other agency representatives.

This poses 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: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
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 6