197609819-9-30-2022-29-AS-JAPL-CKK3EU-20221025181143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609819
Report Date: 09/29/2022
Date Signed: 09/30/2022 12:08:08 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
07/11/2022 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20220711133140

FACILITY NAME:	NANA'S DREAM HOUSE FACILITY		FACILITY NUMBER:	197609819
ADMINISTRATOR:	BADALYAN, NAIRA		FACILITY TYPE:	740
ADDRESS:	7333 IRVINE AVE		TELEPHONE:	(818) 392-0843
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 5	DATE:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	01:32 PM
MET WITH:	Naira Badalyan		TIME COMPLETED:	03:33 PM

ALLEGATION(S):

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Staff do not ensure a safe and healthful environment by inappropriately disciplining a resident in care.
Staff did not aid resident's incontinence needs.

INVESTIGATION FINDINGS:

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On 09/29/2022, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to investigate the above allegations. At 1:30 p.m., the LPA arrived at the facility, met with Administrator Naira Badalyan, and explained the reason for the visit.

On 07/20/2022, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced visit to investigate the above allegations. At 2:00 p.m., the LPA arrived at the facility, met with Administrator Naira Badalyan, and explained the reason for the visit. The LPA and the administrator conducted a brief toured of the facility at 2:10 p.m. LPA Urena conducted staff’s and residents’ interviews from 2:15 p.m. to 2:30 p.m., and review records from 2:30 pm to 3:30 p.m. On this day the LPA observed four residents seating at the dining room table engaged in a game of Bingo.

Continues on LIC 9099 C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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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Control Number 29-AS-20220711133140

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: NANA'S DREAM HOUSE FACILITY	FACILITY NUMBER: 197609819
	VISIT DATE: 09/29/2022

NARRATIVE

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It is alleged that ‘Staff do not ensure a safe and healthful environment by inappropriately disciplining a resident in care’. The Reporting Party’s (RP) concern is that the resident was told to go to their room and not come out. To investigate this allegation, the LPA interviewed four (4) out of six (6) residents. Two residents were unresponsive to the questions asked by the LPA. Four (4) residents stated that they were happy residing in the facility, thye are treated with respect, and staff do not discipline them. The LPA interviewed R1 about how the facility staff treats them, and about being told to go to their room, and the R1 stated that they ‘did not remember’. The R1 stated that they were ok, and did not need anything. The LPA interviewed staff #1(S1) about disciplining residents. The S1 stated that they do not discipline residents. Residents are treated with respect. The LPA interviewed the administrator about staff able to care, and treat residents with respect. The administrator stated that staff are always respectful, and do not punish residents. Based on the interviews and information gathered, it appears that the residents are in a safe and healthful environment, and residents have not been disciplined while in care. Therefore, this allegation is deemed Unsubstantiated at this time.

It is alleged that ‘Staff did not aid resident's incontinence needs’. The Reporting Party’s (RP) concern is that the R1 developed a moderate diaper rash due to the long wear of soiled diapers. The LPA interviewed the RP, staff, residents, and administrator. The RP reported that R1 developed the red rash(circle dime size) on the back, in between his buttocks(cheeks) during an episode of diarrhea; however, the RP stated that they taught the rash developed as a result of the R1 not being changed frequently during the diarrhea episode. The RP stated that this is only time they noticed redness in the buttocks or any other area. The LPA interviewed the staff about the diaper change schedule for residents. The S1 stated that they change the diapers as needed, however they check the diapers every two hours. In the case of R1, the staff assisted R1 to go to the bathroom, because R1 insisted on using the bathroom, even though R1 wears diapers. Staff stated that they use wipes to cleanse the skin, and they apply ointment to prevent skin rashes. They also assess the skin regularly during the change of diapers. During the night, staff was changing the R1’s diaper three to four times. The administrator’s interview revealed that R1’s physician prescribed an oral antibiotic to be taken for 14 days for the diarrhea bout.

Continues on LIC 9099 C...

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220711133140

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: NANA'S DREAM HOUSE FACILITY	FACILITY NUMBER: 197609819
	VISIT DATE: 09/29/2022

NARRATIVE

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The administrator stated that R1 did develop a light skin rash above the buttocks area during the diarrhea episode, however it never developed into an open wound. Furthermore, the administrator stated that they, and the staff continuously checked the rash to ensure that it did not progress into a skin wound. Interview with residents revealed that six out of the six residents do wear or need assistance with a diaper, and that they are changed often and when it is requested by them. Based on the interviews, it appears that staff do aid residents with incontinent needs, and although R1 developed a red rash, it only happened once during the bout of diarrhea. Therefore, this allegation is deemed Unsubstantiated at this time.

No citations were issued. Exit interview was conducted, and a copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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