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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608325
Report Date: 03/09/2023
Date Signed: 03/09/2023 04:20:16 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
07/18/2022 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20220718165118
FACILITY NAME:ZANN DAILY CAREFACILITY NUMBER:
197608325
ADMINISTRATOR:ANN SOLAKYANFACILITY TYPE:
740
ADDRESS:11500 BAIRD AVENUETELEPHONE:
(818) 635-9471
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY:6CENSUS: 5DATE:
03/09/2023
UNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:Ann SlolakyanTIME COMPLETED:
04:28 PM
ALLEGATION(S):
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Due to neglect/lack of Care and Supervision. Resident developed multiple Pressure Injuries while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tihesha Smith made a visit to this facility at 2:40 pm to interview Resident #1 (R1) and to deliver findings. LPA Smith met with facility staff and administrator was contacted. LPA spoke with administrator Ann Slovakyan who revealed is currently picking up (R1) from medical appointment and will be on way to the facility shortly.

On 11/07/22 at 12:47 PM (LPA) Smith made a complaint visit to this facility. LPA Smith had a phone conversation with administrator at 12:55 and disclosed purpose of visit revealed administrator at medical facility and unable to come to facility. LPA conducted tour of the physical plant at 1:45 pm and requested copies of documents relevant to the investigation.
During initial visit, on 07/19/22, (LPA) Abeye Duguma conducted a physical plant tour at around 09:45 AM and interviewed one staff from 10:00 AM - 11:00 AM. At 11:15 AM LPA requested pertinent documents.
(Cont to 9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
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 2
Control Number 31-AS-20220718165118
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: ZANN DAILY CARE
FACILITY NUMBER: 197608325
VISIT DATE: 03/09/2023
NARRATIVE
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(Cont forn 9099)

Due to neglect/lack of Care and Supervision, resident developed multiple pressure Injuries while in care.

It was alleged that due to neglect/lack of care and supervision, resident developed multiple pressure Injuries while in care. To investigate the allegation interviews were conducted with administrator on 07/19/2022, including telephone interviews with administrator on approximately 11/07/22, 03/01/23 and 03/07/23. Documents relevant to the investigation were obtained and reviewed. Telephone interviews also conducted with witness relevant to investigation on 02/15/23. Interview with administrator revealed R1 was assessed upon arrival and any bruising/wound was documented on assessment form on admission.. Administrator also revealed was informed by R1 family that R1 had previously sustained fractures and multiply falls while living at home and in other facility. Interview with witness relevant to investigation revealed that R1 sustained several falls with significant bruising and fall on approximately 05/30/22 resulted in fractures. According to witness paramedics were called to R1s home and R1 was not fully healed due to other health conditions of R1. Review of would assessment document and photos reveal location of shunt and bruising’s on R1s body. The assessment and photos also show 1 (one) small wound on buttocks. Interview with R1 reveal staff treats them fair and do not neglect or mistreat them. R1 revealed they are taken to doctor appointments and they are doing fine at the facility.

Based on interviews and documents obtained during this and previous licensing visits there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2