197609828-8-19-2022-31-AS-NMAN-CHVQ2D-20220902114657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609828
Report Date: 08/18/2022
Date Signed: 08/19/2022 08:42:03 AM

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
05/13/2021 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20210513145312

FACILITY NAME:	NO PLACE LIKE HOME FOR GOLDEN AGES 3, LLC		FACILITY NUMBER:	197609828
ADMINISTRATOR:	MELIK, DIANE		FACILITY TYPE:	740
ADDRESS:	3754 MONTROSE AVE.		TELEPHONE:	(747) 255-7188
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91214
CAPACITY:	6	CENSUS: 5	DATE:	08/18/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Jenick Mausakhanian, Staff		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Facility is not allowing a resident to have visits

Facility is not allowing a resident to have phone calls

Facility is not allowing a resident to have personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit to deliver the findings for the above noted allegations. LPA met with Jenick Mausakhanian, Staff. The purpose of the visit was discussed.

It was reported that the facility is not allowing a resident to have visits. During the investigation on 10/26/2021, for complaint control #31-AS-2021021084126, at 11:26am, staff interviews were initiated. Staff interviews revealed that Resident #1 (R1) was being allowed to have visits and that a visitor had come to the facility in the month of May to visit. On 10/22/21, this information was confirmed, when R1's responsible party told LPA that the facility had allowed a visitor into the facility. Between 12:00pm and 1:00pm on 8/18/2022, residents were interviewed. 5 out of 5 residents were interviewed and they stated that visitors have always been allowed, to enter the facility, even during the pandemic.

Based on interviews and records review, there is not sufficient information to support this allegation.
See-9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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 31-AS-20210513145312

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: NO PLACE LIKE HOME FOR GOLDEN AGES 3, LLC	FACILITY NUMBER: 197609828
	VISIT DATE: 08/18/2022

NARRATIVE

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Therefore, the allegation is UNSUBSTANTIATED at this time.

It was alleged that facility is not allowing a resident to have phone calls. To investigate this allegation, LPA spoke to staff. Interviews revealed that facility does allow residents to receive calls. The facility denies that R1 was not allowed to receive or make calls. In addition, on 8/16/2022, between 12:00pm and 1:00pm, 5 out of 5 residents were interviewed. Interviews revealed confirmed the information that staff had provided to LPA. The residents stated that they are allowed to make and receive calls.

Based on interviews, there is not sufficient information to support this allegation. Therefore, this allegation is deemed UNSUBSTANTIATED.

It was reported that facility is not allowing a resident to have personal property. To investigate this allegation on 10/22/2021, LPA spoke to R1's responsible party and they stated that a visitor had dropped off R1's hearing aids. On 10/26/2021 at 11:26pm. this information was confirmed by facility staff. Furthermore, on 8/18/2022, between 12:00pm and 1:00pm, 5 out of 5 residents were interviewed. Interviews revealed that residents are allowed to have personal belongings. They further stated that they are allowed to order items online and to have them delivered to the facility.

Based on interviews, there is not sufficient information to support this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during this visit.

Exit interview was conducted and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC9099 (FAS) - (06/04)

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