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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610177
Report Date: 11/22/2022
Date Signed: 11/22/2022 03:43:13 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
11/21/2022 and conducted by Evaluator Nicholas Reed
COMPLAINT CONTROL NUMBER: 31-AS-20221121151539
FACILITY NAME:ANNA'S HOME & PARADISEFACILITY NUMBER:
197610177
ADMINISTRATOR:ARMENYAN, ANNAFACILITY TYPE:
740
ADDRESS:23463 HAYNES STTELEPHONE:
(323) 660-0001
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:6CENSUS: 3DATE:
11/22/2022
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Anna MalkhasyanTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Residents were left unattended.
INVESTIGATION FINDINGS:
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At 12:00 p.m. on 11/22/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. LPA and staff toured the facility inside and out. No immediate health and safety concerns were observed.

At 12:15 p.m. LPA conducted a record review. At 12:25 p.m. LPA interviewed Staff #1 (S1). At 12:35 p.m. LPA called and interviewed the administrator. At 12:45 p.m. LPA interviewed Resident #1 (R1). At 2:35 p.m. LPA interviewed Resident #2 (R2). At 3:25 p.m. LPA received photographs from facility cameras from the Administrator.

Regarding the allegation above, it was alleged residents were left unattended on 11/20/2022. From interviews, an employee from an outside agency did not recognize the individual providing supervision to residents. S1 had a family emergency and left at 10:00 a.m. (continued on LIC 9099-C page)
Unsubstantiated
Estimated Days of Completion: 1
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
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-20221121151539
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: ANNA'S HOME & PARADISE
FACILITY NUMBER: 197610177
VISIT DATE: 11/22/2022
NARRATIVE
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Both S1 and the Administrator confirmed that Staff #2 (S2) was present and providing supervision. From record review, the Administrator showed images from the facility cameras that showed S2 at the facility during the time S1 left.

Based on interviews and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided. Appeal rights discussed.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2