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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608084
Report Date: 04/26/2022
Date Signed: 04/26/2022 05:11:34 PM

Document Has Been Signed on 04/26/2022 05:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 #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
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tina Arutyunyan and Akop Ekimyan- Licensee RepresentativesTIME COMPLETED:
01:00 PM
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An office meeting was held at the Monterey Park Adult and Senior Care Regional Office (MP ASCRO) to deliver the Final Findings of a Trust Audit Report involving the following facilities: Our Sweet Home Inc 197607711, Our Sweet Home Inc #2 197608083, Our Sweet Home Inc #3 197608084, Skyhill Quality Living 197608910, Skyhill Quality Living #2 197609098. Attendees present during the meeting were: Licensee Representative Tina Arutyunyan, CCLD Regional Manager Aracely Ramirez, A Manager of CCLD Audit Department Jacqueline Juarez, Licensing Program Manager Lisa Hicks, Licensing Program Manager Naira Margaryan, Licensing Program Analyst(s) (LPAs) Yelena Avetisyan, Tuesday Cabiness, Rosaura Valenzuela, Naomi Garanza and Mary Flores. The purpose of the meeting was explained to Licensee Representatives.

On 09/01/2021 Community Care Licensing Division received complaints against all above noted facilities operated by the same Licensee. The complainant was alleging financial abuse of the residents personal and incidental (P&I) funds. An initial investigation visit was conducted on 09/01/2021. As a part of the complaint investigation, this complaint was referred to CCLD Audit Department for a Trust Audit. Audit investigation conducted by Jacqueline Juarez concluded the following:

* The Licensee/Administrator Misappropriated residents personal and incidental (P&I) funds. Multiple residents did not have access to or were not distributed P&I funds.

* The Licensee/Administrator failed to maintain adequate safeguards and records for residents' cash resources. Proper documentation for expenditures was not maintained.

* The Licensee/Administrator Commingled the residents P&I money with the facility funds.

See 809-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
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
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At the time of the meeting Auditor Jacqueline Juarez Delivered Financial Audit Report and discussed required plan of corrections. The 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 that P&I funds have been deposited in a separate trust account.

On 10/12/2022, 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. The deficiencies related to the complaint allegation also were discussed at the time of this visit and were disclosed in the final complaint investigation report delivered to the Licensee Representative at the time of this Office meeting. See Subsequent visit report of the Complaint Control Number 31-AS-20210824093316.

At the time of this visit the Licensee was informed that the facility plan of operation must be updated to identify the acceptance of the residents placed by Brilliant Corners. The updated information must be submitted to CCL by 05/10/2022..

The Licensees/Administrators were referred to participate to the Technical Support Program(TSP). The brochure regarding the TSP program was e-mailed to the Licensees at the time of this visit. At the time of this visit Licensee Representatives were informed that all facilities will be closely monitored and quarterly visits will be conducted to ensure that the facility is operating in compliance with Title 22 Regulations.

Exit interview was conducted and a copy of this report was issued to the Licensee Representatives.
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
LIC809 (FAS) - (06/04)
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