197609651-3-22-2023-29-AS-JAPL-CQYVXR-20230417164957

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609651
Report Date: 03/22/2023
Date Signed: 03/22/2023 12:42:42 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230316141904

FACILITY NAME:	VILLA CATHERINE SENIOR CARE FACILITY		FACILITY NUMBER:	197609651
ADMINISTRATOR:	VIKTORYA HAYRAPETYAN		FACILITY TYPE:	740
ADDRESS:	7001 VAN NOORD AVE		TELEPHONE:	(818) 279-4309
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 5	DATE:	03/22/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ruzanna Sukiassyan		TIME COMPLETED:	12:46 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff transfer resident in a rough manner resulting in bruising.
Staff yell at resident.
Staff make inappropriate comments towards resident.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst(LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegations above. The LPA arrived at 10:00a.m., and was greeted by staff. The staff contacted the Administrator via phone, and the LPA explained the reason for the visit. Administrator arrived at 10:44 a.m.

At 10:10 a.m. the LPA conducted a brief tour of the physical plant. From 10:15 a.m. to 10:25 a.m. LPA Urena interviewed residents, and from 10:45 a.m. to 11:30 a.m., the LPA interviewed the Administrator.

Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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 3

Control Number 29-AS-20230316141904

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VILLA CATHERINE SENIOR CARE FACILITY	FACILITY NUMBER: 197609651
	VISIT DATE: 03/22/2023

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

Staff transfer residents in a rough manner resulting in bruising.
On the allegation that ‘Staff transfer residents in a rough manner resulting in bruising’; it is the complainant’s concern that the staff transfers the residents very aggressively, and move them in any type of way they can to get them transferred. To investigate the complaint, LPA attempted to interview the residents, and two(2) out of five(5) residents revealed that they are ‘ok’, however their expressive language was limited, and could not provide full sentence answers. Three (3)residents were unable to answer questions due to their conditions. The LPA interviewed the Administrator, and they stated that they are not aware of the staff being aggressive with residents, while being transferred or at any time of the day. On 03/21/2023, the LPA interviewed R1’s responsible party (RP) who stated that while R1 was at the hospital, R1 had multiple IVs, which R1 attempted to remove forcefully. R1 has been prescribed blood thinners since they left the hospital. RP stated that R1 returned to the facility, and the bruises on R1’s arm may have been a result of the IVs, and R1 attempting to remove them. RP was made aware of the bruises on R1’s chin by the administrator, and was brought to the attention of the hospital staff by the administrator.
While interviewing residents, the LPA conducted a visual inspection of residents, and all appeared to be ok, no bruising was noted on their exposed skin.

Based on the information obtained through observation and interviews, there is not sufficient evidence to support the allegation that Staff transfer residents in a rough manner resulting in bruising Therefore, the allegation is deemed Unsubstantiated at this time.

Staff yell at residents
On the allegation that ‘Staff yell at resident’; it is the complainant’s concern that the staff’s tone of voice was condescending, rather than encouraging towards the resident, and yelling to the resident#1(R1), when giving instructions to R1. To investigate the complaint, LPA Urena interviewed two out of five residents. The interviews revealed that they are ‘ok’ Additionally, the LPA interviewed the Administrator and responsible parties(RP). The Administrator stated that the staff (due to their ethnicity) tend to be dry in their expressive language, and tend to use a higher tone of voice, which may appear to visitors that they are yelling. Additionally, because the residents are hard of hearing, the staff may raise their tone of voice. Administrator stated that they are not aware of staff yelling at residents. The LPA interviewed R1’s responsible party, and the RP stated that since R1 has been at the facility, they have observed facility staff to be kind, sweet, and loving towards R1. R1 seems to be happy and smiling since they have been at facility.
Continues on LIC 9099C...

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20230316141904

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VILLA CATHERINE SENIOR CARE FACILITY	FACILITY NUMBER: 197609651
	VISIT DATE: 03/22/2023

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

Although the allegation may have happened, based on the information obtained through observation and interviews, there is not sufficient evidence to support the allegation that staff yells at residents. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff make inappropriate comments towards resident.
On the allegation that ‘Staff make inappropriate comments towards resident’; it is the complainant’s concern that the staff are making inappropriate comments about R1’s appearance. To investigate the complaint, LPA Urena interviewed residents. However, the residents were unable to answer the questions asked by the LPA due to their conditions.
The LPA interviewed the Administrator about staff making inappropriate comments, and the administrator stated that they have never witness staff make inappropriate comments, they continuously work with staff, and train them on how to work with the residents. The LPA interviewed the residents’ responsible parties(RP), and the interview revealed that staff appear to be patient, and kind to the residents.

Although the allegation may have happened, based on the information obtained through observation and interviews, there is not sufficient evidence to support the allegation that staff make inappropriate comments towards resident. Therefore, the allegation is deemed Unsubstantiated at this time.

No citations were issued. Exit interview was conducted via phone with the Administrator. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3