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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609748
Report Date: 11/18/2022
Date Signed: 11/28/2022 08:06:51 AM

Substantiated


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
11/15/2022 and conducted by Evaluator Patrick Shanahan
COMPLAINT CONTROL NUMBER: 31-AS-20221115135709
FACILITY NAME:GRANADA GOLDEN YEARSFACILITY NUMBER:
197609748
ADMINISTRATOR:ARUTYUNYAN, SEVAKFACILITY TYPE:
740
ADDRESS:17201 LAHEY STTELEPHONE:
(818) 535-9693
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: DATE:
11/18/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Rita Babayan / StaffTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility is in disrepair
Staff forced residents to discard used toilet paper in the trash can
Staff did not report an incident as required
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above allegations. The LPA was made aware of all issues prior to receiving this complaint and all allegations were addressed during a Case Management visit on 11/7/2022. The LPA was able to speak to staff and the administrator regarding this visit.

Allegation 1. Facility is in disrepair
On 11/7/2022 the LPA conducted a case management visit to the home. The LPA was able to interview staff, the administrator and the residents regarding this issue. Staff and the administrator confirmed that a plumbing issue had occurred and that the resident restroom was not functional for about 2 days. While touring room number 3, the LPA also observed that the floor next to the door had buckled and was preventing the door from closing. Based on LPA observation, this allegation is deemed substantiated. The LPA issued a deficiency for this allegation on 11/7/22 and the floor was corrected on 11/13/22 and has since been cleared.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
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-20221115135709
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: GRANADA GOLDEN YEARS
FACILITY NUMBER: 197609748
VISIT DATE: 11/18/2022
NARRATIVE
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Allegation 2. Staff forced residents to discard used toilet paper in the trash can
LPA was able to interview staff, residents and the administrator regarding this allegation on 11/7/2022 during a case management visit. Staff interviewed confirmed that they had told residents not to throw used toilet paper in the toilet after use and to use a trash can. The administrator also confirmed that they had requested that residents use the trash can because the pipes in the house were old and this would prevent the pipes from clogging up. Residents also stated that they were told not to discard toilet paper in the toilet and to use the trash can for the waste. This allegation is deemed substantiated. Deficiencies were issued during the case management on 11/7/2022 and the Plan of Corrections have been received.

Allegation 3. Staff did not report an incident as required
The LPA was able to interview the administrator regarding this allegation on 11/7/2022 during a case management visit. The administrator admitted that she did not submit an incident report regarding the the broken pipe issues or the damage to the floor. The facility was issued a deficiency on 11/7/2022 and the plan of correction has since been submitted. Based on the admission from the administrator, this allegation is deemed substantiated at this time.

Exit interview conducted and report issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2