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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609749
Report Date: 06/22/2021
Date Signed: 06/22/2021 01:54:44 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
05/20/2021 and conducted by Evaluator Patrick Shanahan
COMPLAINT CONTROL NUMBER: 31-AS-20210520092102
FACILITY NAME:ENCINO GARDENSFACILITY NUMBER:
197609749
ADMINISTRATOR:ARUTUNYAN, ALEXFACILITY TYPE:
740
ADDRESS:4930 NOELINE AVETELEPHONE:
(818) 983-5598
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:6CENSUS: 5DATE:
06/22/2021
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Mariam Balasanyan/TIME COMPLETED:
02:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not allow resident to have a visitor
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Patrick Shanahan, Angela Panushkina, and Melissa Ruiz arrived at the facility in order to deliver findings for the above mentioned allegation.

On 5/25/21 at about 1:00 PM, LPA Shanahan, interviewed the resident in question (R1). LPA was also able to interview R1 on this date at about 11:00am regarding the allegation above. During the interview, R1 confirmed that R1 and R1's conservitor did not allow access to one of R1's visitors. R1 informed staff to collect documentation from the visitor and to not allow access, which the facility staff did. At about 9:30 AM, all other residents were interviewed regarding this allegation and all residents confirmed that they do allow visitation. LPA's observed several visitors at the facility during todays visit.

Based on resident interviews and LPA's observations, this allegation is deemed unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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