197610152-8-9-2023-31-AS-NGID-CUWNNA-20230821103623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610152
Report Date: 08/09/2023
Date Signed: 08/09/2023 02:55:21 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/28/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230428164713

FACILITY NAME:	PALACE OF JOY		FACILITY NUMBER:	197610152
ADMINISTRATOR:	GRIGORYAN, MARINE		FACILITY TYPE:	740
ADDRESS:	6701 KURL WAY		TELEPHONE:	(747) 265-6536
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 5	DATE:	08/09/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Hranush Khachatryan, Staff		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not have the residents' medications locked.
Facility staff did not speak English for emergency situations.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At 10:00am, Licensing Program Analysts (LPAs) Angela Panushkina and Christopher Alemoh conducted a subsequent visit to this facility to deliver final findings. LPA met with Hranush Khachatryan, Staff #1 (S1) who granted access to the facility. Administrator was contacted and the reason for the visit was explained. Administrator informed LPA that she's unable to come in and designated S1 to sign the report.

During the initial visit conducted on 05/05/23, interviews and record review were made. At 10:10am, LPA met with the Administrator and requested resident and staff roster. At approximately 10:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. At 11:00am, LPA requested copies of pertinent information which include, but not limited to Physician’s report, Appraisal Needs and Services Plan, Resident Appraisal, etc., relevant to the investigation. Between 10:25am – 12:30pm, LPA interviewed the Administrator, two (2) staff members and six (6) residents.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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-20230428164713

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: PALACE OF JOY	FACILITY NUMBER: 197610152
	VISIT DATE: 08/09/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Facility staff did not have the residents' medications locked.

Regarding this allegation, LPA inspected the medication system, during the initial and today's visit. LPA observed that all the client medications are centrally stored, locked in a file cabinet by the kitchen, and inaccessible to the residents in care. Only the Administrator and staff have access to this cabinet. The key is kept with staff at all times. Also, during today's visit LPAs inspected the kitchen counter top, and other common areas and did not observe any medication in the open. Residents also did not have any medications stored in their bedrooms or bathrooms. Based on inspection of the physical plant, the allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff did not speak English for emergency situations.

Although, during the initial visit (on 05/05/2023), LPA was unable to interview the identified staff members, LPA conducted interviews with four (6) out of six (6) residents and interviews revealed that staff was able to communicate and meet their needs and call paramedics for an immediate/emergency situation. Also, on 05/05/23 visit, LPA observed that Ms. Khachatryans (S1 and S2) English was limited, but they were still able to communicate. LPA asked them questions regarding their duties and procedures to take in case of emergencies, to which they were able to respond and communicate effectively. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2