197610207-9-3-2024-31-AS-NMAN-D92VZL-20240912165255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610207
Report Date: 09/03/2024
Date Signed: 09/03/2024 03:49:41 PM

Unfounded

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
05/17/2024 and conducted by Evaluator Leizl De La Cerra

COMPLAINT CONTROL NUMBER: 31-AS-20240517144753

FACILITY NAME:	AMORE VILLA		FACILITY NUMBER:	197610207
ADMINISTRATOR:	MELKONYAN, MARIYA		FACILITY TYPE:	740
ADDRESS:	8455 SPRINGFORD DR		TELEPHONE:	(818) 425-4975
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY:	6	CENSUS: 1	DATE:	09/03/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Kristina Melkonyan, Caregiver		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff left resident unattended.
Staff did not arrange proper transportion for emergency medical services.

INVESTIGATION FINDINGS:

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On 09/03/24 Licensing Program Analyst (LPA) Leizl de la Cerra conducted a subsequent unannounced visit and was greeted by caregiver, Kristina Melkonyan. LPA stated the purpose of the visit. The administrator was on the phone and informed LPA that they were unavailable and gave consent to the caregiver to sign the report.At approximately 11:00am, LPA de la Cerra conducted a tour of the facility and LPA conducted interviews with the staff and the resident present at the facility

Allegation: Staff left resident unattended. To investigate the allegation LPA conducted interview with caregiver, S1. It is alleged that a staff member from the facility did not attend to R1 by placing R1 in an UBER rideshare without a staff member accompanying R1 in the UBER rideshare transportation. Interview with S1 confirm that residents have never been left unattended inside or outside the facility. R1 interview confirmed that R1 has never been left unattended inside or outside the facility. Furthermore, neither resident nor administrator have any knowledge of who the unattended individual, R1 is. Based on overall investigation it was concluded that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, is deemed UNFOUNDED at this time.
-CONTINUED TO LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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-20240517144753

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: AMORE VILLA	FACILITY NUMBER: 197610207
	VISIT DATE: 09/03/2024

NARRATIVE

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Allegation: Staff did not arrange proper transportation for emergency medical services. To investigate the allegation LPA conducted interviews with one (1) out of one (1) resident who is present at the facility. LPA interviewed administrator, S1.
It is alleged that a staff member from the facility placed R1 in a UBER rideshare transportation which is not a medically equipped vehicle to transport R1 to Olive View Emergency Room,
Interviews with one (1) resident and one (1) staff was confirmed that UBER rideshare is not the proper form of transportation used for emergency medical services. Furthermore, neither resident nor staff member does not have any knowledge of any individual from the facility transported to Olive View Emergency by UBER rideshare. Based on overall investigation it was concluded that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, is deemed UNFOUNDED at this time.

This agency had investigated the complaints and we have found that the complaints were without a reasonable basis. We have therefore dismissed the complaints.

LPA did not observe any health and safety issues.
Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC9099 (FAS) - (06/04)

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