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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610171
Report Date: 11/14/2022
Date Signed: 11/14/2022 12:43:56 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
11/09/2022 and conducted by Evaluator Joscelyn Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20221109162302
FACILITY NAME:HEART TO HEART SENIOR LIVINGFACILITY NUMBER:
197610171
ADMINISTRATOR:VERONIKA YEBEYANFACILITY TYPE:
740
ADDRESS:9330 ALDEA AVETELEPHONE:
(747) 202-0923
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:6CENSUS: 6DATE:
11/14/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Veronika Yebeyan TIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff are not following infection control practice
INVESTIGATION FINDINGS:
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On 11/14/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conducted an unannounced complaint investigation. Upon arrival LPA was met by staff and LPA's temperature was taken. LPA was asked to sign in and the purpose of the visit was explained. LPA later met with administrator Veronika Yebeyan and the purpose of the visit was explained.

At 11:15 a.m LPA conducted a tour of the facility. LPA observed residen'ts visitors wearing mask as well as the staff. No health and saftey issues observed .

Allegatiion:
Staff are not following infection control practice

It is alleged that on 09/12/22 a credible witness arrived at the facility and observed staff not wearing a mask, nor where they screen upon arrival. Interview with administrator revealed that on 09/12/22, adminsitrator arrived at the facility once the credible witness was leaving the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
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-20221109162302
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: HEART TO HEART SENIOR LIVING
FACILITY NUMBER: 197610171
VISIT DATE: 11/14/2022
NARRATIVE
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 Administrator and the credible witness spoke outside of the facility therefore, administrator was not required to wear a mask. Interview with two (2) out of (2) staff revealed that they wear their mask inside the facility and screen visitors upon arrival. Due to insufficient evidence this allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2