197608349-1-16-2025-31-AS-EMIR-DGUQWC-20250520123143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608349
Report Date: 01/16/2025
Date Signed: 01/16/2025 02:19:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
12/27/2024 and conducted by Evaluator Raymond Comer

COMPLAINT CONTROL NUMBER: 31-AS-20241227120620

FACILITY NAME:	ABBEY ROAD VILLA		FACILITY NUMBER:	197608349
ADMINISTRATOR:	MARINE KARAPETIAN		FACILITY TYPE:	740
ADDRESS:	14132 HUBBARD STREET		TELEPHONE:	(818) 837-0077
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	78	CENSUS: 67	DATE:	01/16/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Marine Karapetian		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident is not getting appropriate incidental medical care-
Resident’s dietary needs are not being met-
Staff failed to ensure proper medication assistance-
Staff is neglecting Resident care and supervision-

INVESTIGATION FINDINGS:

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On Thursday, 1/16/25, at 10:00 am, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct a subsequent visit regarding the allegation(s) listed above. LPA conducted the initial complaint visit on 1/06/25. LPA met with facility Administrator, Marine Karapetian, presented official CDSS badge identification, and reason for the visit was disclosed.

At 10:10 am, A physical plant tour of the facility was conducted by LPA; No health and safety issues were observed.

To investigate the allegation(s), LPA received Facility resident roster, and Staff roster. At 10:15 am, LPA reviewed Resident 1's (R1) file, and other documents relevant to the investigation. Between 10:45 am and 12:30 pm, LPA conducted on-site interviews with Staff, and Residents.

[LIC 809-C Continued]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

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 3

Control Number 31-AS-20241227120620

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ABBEY ROAD VILLA	FACILITY NUMBER: 197608349
	VISIT DATE: 01/16/2025

NARRATIVE

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Allegation: Staff failed to ensure proper medication assistance - The Reporting Party (RP) alleges that Resident#1 (R1) is not encouraged by staff to take their medications daily.
To investigate the allegation, LPA conducted a records review of R1's file, which revealed the following: Medical Administration Records (MAR) indicate staff tracking of prescribed medications taken/refused by R1. LPA interviews with staff revealed the following: Both Administrator and staff deny the allegation, stating that R1 is encouraged by staff to take their medicine, despite occasional refusals. LPA interview with R1 revealed the following: R1 states that "[staff] try to get me to take my meds...even when I don't want to". LPA interviewed a total of seven (7) residents. Six (6) out of seven (7) residents do not corroborate the allegation, stating that staff do provide proper medication assistance.

Although this allegation may have occurred, or is valid, there is not a preponderance of evidence to prove the alleged did, or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

Allegation: Staff is neglecting Resident care and supervision - The Reporting Party (RP) alleges that Resident#1 (R1) is not assisted by staff to accomplish their Activities of Daily Living. (ADL's)
To investigate the allegation, LPA conducted a records review of R1's file, which revealed the following: Review of R1's care plan shows R1 requires assistance with bathing, dressing, grooming, and encouragement to take medications on a daily basis. LPA interviews with Administrator and staff revealed the following: Staff deny the allegation, stating that staff assist R1 with their ADL's on a daily basis. LPA interviewed R1, who states that staff do provide them assistance with their daily needs. LPA interviewed a total of seven (7) residents. Six (6) out of seven (7) residents do not corroborate the allegation, stating that staff are providing resident assistance to meet daily needs.

Although this allegation may have occurred, or is valid, there is not a preponderance of evidence to prove the alleged did, or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 31-AS-20241227120620

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ABBEY ROAD VILLA	FACILITY NUMBER: 197608349
	VISIT DATE: 01/16/2025

NARRATIVE

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Allegation: Resident is not getting appropriate incidental medical care- The Reporting Party (RP) alleges that Resident#1 (R1) was not provided staff assistance in scheduling and transporting R1 to medical appointments.
To investigate the allegation, LPA conducted a records review of R1's file, and other relevant documents, which revealed the following: Records show appointments scheduled for neurologist, ophthalmologist, cardiologist specialists, etc. For this investigation, LPA interviewed a total of four (4) staff, which revealed the following: Both Administrator and staff deny the allegation, stating incidental medical needs, including making appointments are met. LPA interviewed R1, who states that staff do schedule their doctor appointments, and prep R1 to ensure they are ready to be transported to the doctor's office. During the investigation, LPA interviewed a total of seven (7) residents. Six (6) out of seven (7) residents do not corroborate the allegation, stating that staff do provide assistance with their incidental medical needs.

Although this allegation may have occurred, or is valid, there is not a preponderance of evidence to prove the alleged did, or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

Allegation: Resident’s dietary needs are not being met- The Reporting Party (RP) alleges that Staff do not provide Resident#1 (R1) the proper diet as stated in the care plan, and that food for R1 is not available during un-scheduled meal periods.
To investigate the allegation, LPA conducted a records review of R1's file, and other relevant documents, which revealed the following: Records show R1 is required to be on a "renal diet". LPA conducted a observation of the facility kitchen and found a post listing R1, and all other residents requiring renal and diabetic restrictions. LPA Interviews with Administrator and kitchen staff revealed the following: Staff deny the allegation, stating R1 is provided a low salt/low sugar diet, with moderate protein portions. LPA interviewed R1, who states that staff do provide food to them during routine meal times, and "after-hour" meals/snacks when requested. During the investigation, LPA interviewed a total of seven (7) residents. Six (6) out of seven (7) residents do not corroborate the allegation, stating that staff do provide "after-hour" meals and snacks when requested.

Based on the information gathered from this investigation, Although this allegation may have occurred, or is valid, there is not a preponderance of evidence to prove the alleged did, or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.
[LIC 809-C Continued]

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

LIC9099 (FAS) - (06/04)

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