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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610305
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:39:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
02/08/2023 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20230208125524
FACILITY NAME:BRIGHTSTAR SENIOR CARE,INCFACILITY NUMBER:
197610305
ADMINISTRATOR:ALLAHDADI, AYEDEHFACILITY TYPE:
740
ADDRESS:10455 GAYNOR AVETELEPHONE:
(818) 517-0544
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 6DATE:
07/20/2023
UNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:Ayedah AllahdadiTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not respond to resident's requests for assistance in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Evelin Rios and Michael Cava conducted a subsequent complaint visit to follow-up with the facility about the above allegation. LPAs met with the administrator, Ayedah Allahdadi and explained the purpose of the visit.

Allegation: Staff did not respond to resident's requests for assistance in a timely manner.
In regards to the allegation, it was reported that staff did not respond to resident when they pushed their call button. Interviews with staff Narineh Ohanian on 2/13/2023 indicated that resident #1 (R1) would continuously push her call button and requested to know the time it was in the middle of the night. According to Narineh because staff knew it was R1 requesting to know the time at night they removed her call button. Interview with R1 and R1's roommate resident #2 (R2) revealed R1 would become disoriented at night and consistently request to know the time becasue R1did not know if it was morning, staff would no longer respond to R1's request. Based on interviews the allegation is deemed Substantiated at this time.
Deficiencie issued. Exit interview conducted. Appeal rights and a copy of the report was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
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 3
Control Number 31-AS-20230208125524
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BRIGHTSTAR SENIOR CARE,INC
FACILITY NUMBER: 197610305
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights of Residents in Privately Operated Facilities.
To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by:
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Administrator is to submit to LPA a plan to ensure that Section 87468.2(a)(4) will be complied with at all times.
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Various interviews and observation revealed that staff did not responded to the call for assistance from R1. This poses a potential health and safety risk to the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3