197610223-2-15-2025-31-AS-EMIR-DERQ7H-20250314115511

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610223
Report Date: 02/15/2025
Date Signed: 02/15/2025 02:23:32 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
01/31/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20240131142742

FACILITY NAME:	NVM COMFORT HOMES		FACILITY NUMBER:	197610223
ADMINISTRATOR:	AGARONYAN, RIMA		FACILITY TYPE:	740
ADDRESS:	16473 MCKEEVER ST		TELEPHONE:	(818) 300-8393
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 4	DATE:	02/15/2025
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Rima Agaronyan		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident sustained a pressure injury while in care
Staff did not seek medical care for resident in care in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. The ten-day visit to this investigation was made on 02/03/24. LPA met with the administrator, Rima Agaroynyan, and advised her of the complaint. LPA Cava’s investigation consisted of interviews with facility administrator, hospital staff, facility staff, residents and record review of hospital and facility records.

In regards to the allegations, it was reported that Resident 1 (R1) was discharged from a Skilled Nursing Facility (SNF) to the Residential Care Facility for the Elderly (RCFE) on or around 11/10/23. At the time of discharge from the SNF, R1’s skin was intact. On or around 12/6/23, R1 was sent to ER with a pressured sore on the lower back. The licensee indicated that they had noted a wound over the past weeks. A referral had been sent for Home Health wound care, but when nurse got to the facility, R1's wound needed to be debrided and referred R1 to the emergency room (ER). R1 was sent back to the facility following this ER

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2025

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-20240131142742

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: NVM COMFORT HOMES	FACILITY NUMBER: 197610223
	VISIT DATE: 02/15/2025

NARRATIVE

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visit. On 12/20/23, R1 was admitted to the hospital for wound care.

According to the administrator, Rima Agaronyan, R1 was admitted to the facility 11/10/23. The SNF never notified her of any wounds. Review of R1’s physician report and preplacement appraisal also do not indicate any wounds or skin break downs. After admission, on or around 11/10/23, while R1 was getting assistance with bathing, staff observed a wound. Home Health (HH) was notified on 11/11/23. The administrator was advised that a nurse will come out within 24 hours. When the HH Nurse came out to make an assessment, there was no indication by the nurse, at that time, of the wound being open. R1 was still sent to the hospital, but it was agreed that R1 can return to the facility as wound was not greater than stage 2.

Review of the hospital records indicate the following:
11/10/23: R1 was discharged from Rehab to the board and care.
11/17/23: Home Health referral from primary care physician for physical therapy and wound care (nurse to apply cream to R1's wound).
12/05/23: R1 assessed to have stage 2 pressure ulcer.
12/06/23: R1's wound possibly progressed to unstageable. R1 was sent to Emergency Department (ED).
12/06/23: R1 sent to ED for evaluation. Chief Complaint- Pressure Ulcer Assessment. There was a Decubitus ulcer present, but no increased signs of warmth, signs of infection, discharge, significant tenderness or any indication for acute intervention. Case Manager met with the licensee and R1’s responsible person. They were all comfortable and agreed to have R1 going back to the facility.
12/20/23: HH nurse indicated wound not healing and has a lot of dead tissue. Referral to clinic.
12/20/23: There was another indication of wound progressing to possibly stage 3 and 4. Debrided to healthy bleeding tissue. R1 transported to the hospital. (Per hospital staff interview, nurse confirms R1 was sent back to the hospital on 12/20/23).

Based on the information obtained, although there is record that R1 has a pressure injury, there is evidence that the licensee tended to, and monitored R1’s condition, until it progressed to a possible prohibited condition. There is also evidence that the administrator was in contact with HH regarding R1’s wound. Once R1’s wound did not show improvement, or had progressed, R1 was sent to the ED for immediate medical attention. Therefore, based on the information obtained, the above allegations are deemed Unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2025

LIC9099 (FAS) - (06/04)

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