197610152-5-20-2025-31-AS-NGID-DHJUUV-20250611155409

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610152
Report Date: 05/20/2025
Date Signed: 05/20/2025 04:27:47 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
05/16/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250516105015

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: 6	DATE:	05/20/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Marine Grigoryan, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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MStaff are not meeting resident's toileting needs.
Staff are not meeting resident's hygiene needs.
Staff are not adhering to sanitation protocols.

INVESTIGATION FINDINGS:

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At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with staff Keneshbek Minzhasharov and the staff contacted the Administrator via phone. LPA explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 9:35 AM, LPA requested resident and staff roster. At 9:40 AM, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician Report, Appraisal Needs and Services Plan, Centrally Stored Medication Destruction (CSMD) and etc., relevant to the investigation. At approximately 9:45 AM, LPA conducted a physical plant tour. Between 9:55 AM – 12:45 PM, LPA conducted an interview with the Administrator, a staff, and five (5) out of sxi (6) residents who were able to communicate.

Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

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-20250516105015

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PALACE OF JOY	FACILITY NUMBER: 197610152
	VISIT DATE: 05/20/2025

NARRATIVE

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Staff are not meeting resident's toileting needs.
It is alleged that the facility staff is not able to change Resident #1 (R1) due to the religion restriction of the staff and R1 was covered with feces. To investigate this allegation LPA conducted an interview with the Administrator and it was revealed that on 05/02/2025, R1 was taken care of for the toileting needs accordingly; however, due to the constipation issue R1 was unable to have a normal bowel movement. Additionally, staff place R1 on a bed side commode and again R1 was unable to have any bowel movement. Due to R1 becoming weak R1 asked the staff to place him/her in bed. Later, after R1 made his/here business (bowel movement) in bed and touched his/her own feces. R1 called the staff and asked to be cleaned. Furthermore, interview with two staff confirmed the information provided by the Administrator and informed LPA that the staff are always available to provide all required care including toileting needs. Interview with five (5) out of six (6) residents including R1 stated that the facility staff do meet toileting needs of all the residents in a timely manner and did not express any concerns regarding the above allegation. Therefore, based on the information provided through interviews this allegation is deemed Unsubstantiated at this time.
Staff are not meeting resident's hygiene needs.
It is alleged that R1's phone was filled with feces, and R1 was unable to receive phone calls. Moreover, it is alleged that R1's environment is not clean and sanitary in the facility. To investigate this allegation LPA conducted an interview with the Administrator and it was revealed that on 05/02/2025, R1 had constipation issue. The staff provided bed side commode and R1 was unable to have a bowel movement. Eventually, R1 had a bowel movement in his/her bed. As a result, , R1's phone that was placed in bed got covered with R1's feces. Interview with two staff revealed that after the incident R1, the bed, and the phone were cleaned immediately. Furthermore, LPA conducted an interview with R1 who confirmed that the information provided by both staff and the Administrator. Moreover, R1 informed LPA that due to non-payment of the phone bill R1 was unable to receive any phone calls. Interview with residents stated that all of their hygiene needs are being met and expressed no concerns. Lastly, during today's visit, LPA observed that the facility is following all the hygiene needs of the residents including R1's. LPA observed that the facility is sanitary and clean including R1's room. Based on the interviews and LPA's observation during today's visit this allegation is deemed Unsubstantiated at this time.

Continue on LIC 9099C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20250516105015

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PALACE OF JOY	FACILITY NUMBER: 197610152
	VISIT DATE: 05/20/2025

NARRATIVE

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Staff are not adhering to sanitation protocols.
It is alleged that the facility staff used same gloves that they used to change one resident and changed another resident. To investigate this allegation LPA conducted an interview with the Administrator and two staff. All parties interviewed denied the above allegation and informed LPA that gloves are being changed after providing care and supervision to each resident. LPA was also informed that the same gloves cannot be used for several tasks. Furthermore, during today's visit LPA observed that both staff are wearing new gloves before serving a resident. Lastly LPA observed several boxes full of gloves being stacked in the kitchen closet. Therefore, based on interviews and observation this allegation is deemed Unsubstantiated.

Exit interview conducted. Copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

LIC9099 (FAS) - (06/04)

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