197609980-4-6-2023-29-AS-JAPL-CQU3JW-20230412181814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609980
Report Date: 04/06/2023
Date Signed: 04/06/2023 06:39:21 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
03/20/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230320163750

FACILITY NAME:	AMY'S PARADISE HOME OF ANGELS INC.		FACILITY NUMBER:	197609980
ADMINISTRATOR:	EMMA AVETISYAN		FACILITY TYPE:	740
ADDRESS:	11950 ROSCOE BLVD		TELEPHONE:	(310) 913-6161
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	6	CENSUS: 5	DATE:	04/06/2023
		UNANNOUNCED	TIME BEGAN:	06:10 PM
MET WITH:	Emma Avetisyan		TIME COMPLETED:	07:00 PM

ALLEGATION(S):

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Resident's hygiene needs are not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Sandra Urena conducted a subsequent unannounced visit to deliver the findings for the allegation above. The LPA arrived at 6:10 p.m., and was greeted by staff. The staff contacted the Administrator Emma Avetisyan via phone, and the LPA explained the reason for the visit. Administrator was not able to come to the facility.

On 03/22/2023, Licensing Program Analyst(LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegation above. The LPA and the staff conducted a brief tour of the physical plant. Walls of bedrooms, beds, linens and common areas, bathroom, and hallway areas were observed to be clean, and in good condition. LPA Urena interviewed the Administrator from 2:00 p.m. to 2:30 p.m. The LPA conducted pertinent file review at 2:30 p.m.

Continues on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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-20230320163750

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: AMY'S PARADISE HOME OF ANGELS INC.	FACILITY NUMBER: 197609980
	VISIT DATE: 04/06/2023

NARRATIVE

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On the allegation that ‘Resident's hygiene needs are not being met; it is the complainant’s concern that the residents’ hygiene needs are not being address, due to R1 had dry feces in fingernails, and dried blood (on walls). It was further noted that there was blood on walls, and fecal matter on bed linens. To investigate the complaint the LPA conducted a brief tour of the facility, and on this day all common areas were observed to be in clean condition, bed linens were observed to be clean, and in good condition. The Administrator's interview revealed that R1 had been combative when it came to their hygiene; refusing to allow S1 to clip their nails, and keeping them clean. The Administrator added that on 03/17/2023, R1 attempted to elope the facility, and that R1 fell on the front yard while trying to elope. According to the Administrator, R1 fell on the front yard, and got scrapes on hands, which and may be the cause for the dry blood. The complainant’s report stated that recently R1 had become increasingly difficult to control. On 03/21/2023 at approximately 4:20 p.m., the LPA interviewed R1’s longtime friend (F1), who stated that the last time F1 saw R1 at the facility, it was in mid-February 2023. F1 observed the facility, and R1 to be ‘immaculate clean’, and did not see any signs of neglect.

Based on the information obtained through observation, and interviews, there is not sufficient evidence to support the allegation that the Resident’s hygiene needs are not met. Therefore, the allegation is deemed Unsubstantiated at this time.

No citations were issued. Exit interview was conducted with Administrator over the phone, and signed by the facility representative. A copy of the report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

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