197608585-8-5-2024-31-AS-TAGD-D8TNGR-20240905102731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608585
Report Date: 08/05/2024
Date Signed: 08/05/2024 01:01:23 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
08/01/2024 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240801131144

FACILITY NAME:	BUENA VISTA VILLA RCFE		FACILITY NUMBER:	197608585
ADMINISTRATOR:	GAYANE DZHAGARYAN		FACILITY TYPE:	740
ADDRESS:	2741 N. BUENA VISTA STREET		TELEPHONE:	(818) 478-1357
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY:	6	CENSUS: 5	DATE:	08/05/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	MIchael Petrosyan - Co Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure that a resident had access to their ambulation device
Staff yelled at a resident
Staff did not ensure that the facility was maintained sanitary
Staff did not ensure that the facility was maintained free of odor

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 08/05/24, at 9:50am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Caregiver, Haykuhi Dovlatyan. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, conduct staff and resident interviews and deliver findings for this complaint. The Co-Administrator was called and arrived a few minutes later.

The investigation consisted of the following: LPA Saucedo asked for the census, requested the staff and resident roster. At 10:20am, LPA toured the physical plant. During the tour, LPA interviewed two (2) residents and four (4) staff.

9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024

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-20240801131144

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: BUENA VISTA VILLA RCFE	FACILITY NUMBER: 197608585
	VISIT DATE: 08/05/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation: Staff did not ensure that a resident had access to their ambulation device. It is being alleged that staff did not ensure that the resident's walker was in their room available for the resident to assist. Two (2) residents confirmed that their ambulation device is available for them in their room whenever they want to use it. Resident #1 (R1) stated that they have two (2) walkers. One (1) in their room and one (1) kept outside of their room which is used for outside recreation. Four (4) staff confirmed that the resident's ambulation device is always with them. During the physical tour, LPA observed that R1 had two (2) ambulation devices. One (1) was kept in their room and one (1) directly outside of their room for outside access. LPA also observed another resident (Resident #3) to have their ambulation device/wheelchair in their room. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff yelled at a resident. It is being alleged that a staff yelled at a resident because a door became stuck. Two (2) residents confirmed staff do not yell at them. Four (4) staff confirmed that they do not yell at the residents, and it would not be allowed. During the physical tour, LPA did not observe any of the staff yelling at the residents. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not ensure that the facility was maintained sanitary. It is being alleged that there was feces on one (1) of the bathroom walls. Two (2) residents confirmed that the facility is maintained sanitary and have never seen feces on the wall. Four (4) staff confirmed that they constantly clean throughout the day. During the physical tour, LPA observed staff cleaning. Furthermore, LPA observed two (2) bathrooms which did not have any feces on the walls. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not ensure that the facility was maintained free of odor. It is being alleged that one (1) of the bathroom’s smelled like urine. Two (2) residents confirmed that the facility is maintained free of odor. Four (4) staff confirmed that they constantly clean throughout the day; thus, ensuring there is no odor. During the physical tour, LPA observed the facility free of odor. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Co-Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2