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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610094
Report Date: 08/11/2021
Date Signed: 08/11/2021 06:52:53 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
04/28/2021 and conducted by Evaluator Tuesday Cabiness
COMPLAINT CONTROL NUMBER: 31-AS-20210428144747
FACILITY NAME:WELLNESS ASSISTED LIVINGFACILITY NUMBER:
197610094
ADMINISTRATOR:MELIKSETYAN, LUSINEFACILITY TYPE:
740
ADDRESS:9115 N WYSTONE AVETELEPHONE:
(747) 218-9141
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 5DATE:
08/11/2021
UNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Gloria AbarquesTIME COMPLETED:
07:00 PM
ALLEGATION(S):
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1. Personal Rights
2. Staff not able to communicate effectively to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility at 5pm to complete the investigation pertaining to the allegations mentioned above. LPA met with caregiver Gloria Abarques, who was informed the reason of the visit. The Administrator was contacted. The following was determined:

Allegation # 1: Personal Rights. Concerns were expressed that, staff was not in compliance with the health, welfare, and safety of residents during the pandemic, by not following Department of Public Health, Licensing, and CDC guidelines and procedures of COVID-19. According to the information obtained, staff was not screening visitors, and checking the temperature, as they entered the facility. On May 07, 2021 and August 11, 2021, LPA conducted interviews from different times in the afternoon, ranging from 2pm to 6pm. Before entering the facility, during today’s visit, LPA was greeted by caregiver, and not allowed to
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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-20210428144747
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: WELLNESS ASSISTED LIVING
FACILITY NUMBER: 197610094
VISIT DATE: 08/11/2021
NARRATIVE
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enter, until LPA’s temperature was properly taken. LPA also had to sign in their visitor book. LPA also observed staff with facial covering (mask). Although, it was reported, that staff was not following safety measures during the pandemic, and not properly screening visitors for COVID-19, during today’s visit and through interviews conducted, LPA did not have sufficient evidence, to corroborate the allegation. Therefore, the allegation, “Personal Rights -- staff not in compliance with the health, welfare, and safety of residents”, is UNSUBSTANTIATED at this time.

Allegation # 2: Staff not able to communicate effectively to residents in care. Concerns were expressed that staff are not able to effectively communicate to residents in care. On May 07, 2021 and August 11, 2021, LPA conducted interviews from different times in the afternoon, ranging from 2pm to 6pm. During today’s visit, LPA conducted additional interviews with residents. It was reported to LPA, that are staff and resident can communicate with each other, and there are no problems or issues talking to staff. Although it was reported, staff were not able to speak effective English to residents, during today’s visit, with observations and interviews, LPA does not have sufficient evidence to corroborate the allegation, “Staff not able to communicate effectively to residents in care”, therefore the allegation is UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC9099 (FAS) - (06/04)
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