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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609029
Report Date: 08/05/2021
Date Signed: 08/06/2021 02:44:52 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
07/30/2021 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20210730142744
FACILITY NAME:TERNER CAREFACILITY NUMBER:
197609029
ADMINISTRATOR:TER-NERSESIAN, ANDRANIK AFACILITY TYPE:
740
ADDRESS:13800 WHEELER AVENUETELEPHONE:
(818) 665-9631
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:6CENSUS: 5DATE:
08/05/2021
UNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Andranik Ter-Nersesian - AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff stole resident's valuables
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegation. LPA met with Administrator Andy Ter-Nersesian and explained the reason for the visit.

LPA conducted physical plant tour at 9:00 AM. Requested copies of facility documents relevant to the investigation and reviewed the same at 10:20 AM. LPA interviewed residents, staff and administrator between 10:20 AM to 1:00 PM. LPA also called friend and attempted to call family member of Resident #1 (R1).

It was alleged that the administrator took R1's jewelry on the day R1 left the facility to move back to R1's residence against the administrator's advice. LPA interview with two (2) residents between 10:00 AM to 12:00 PM who were at the facility at the time R1 left, revealed that the administrator was not at the facility on the day R1 left. (continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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-20210730142744
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: TERNER CARE
FACILITY NUMBER: 197609029
VISIT DATE: 08/05/2021
NARRATIVE
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(continued from LIC 9099)

LPA interview with the staff also confirmed that the administrator was not present at the facility. LPA record review also revealed R1 did not declare any valuables on Personal Property and Valuables form (LIC 621) which R1 signed.

Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2