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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610345
Report Date: 05/03/2023
Date Signed: 05/03/2023 02:00:37 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
04/24/2023 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20230424105510
FACILITY NAME:HILDA ASSISTED LIVINGFACILITY NUMBER:
197610345
ADMINISTRATOR:YEGEYAN, MARYFACILITY TYPE:
740
ADDRESS:17179 SAN JOSE STREETTELEPHONE:
(818) 403-1803
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 2DATE:
05/03/2023
UNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Nazar "Nick" YegeyanTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility did not provide refund in a timely manner.
Staff did not seek timely medical care for resident.
Facility forced resident to sign up for hospice.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Nazar "Nick" Yegeyan, and advised him of the complaint. Today's investigation consisted of interviews, record review and an inspection of the physical plant to insure the health and safety of the clients in care. At approximately 8:30am-11:00pm. Interviews made with the administrator and residents. Between 11:00am to 12:00pm, LPA conducted record review. Betweem 12:00pm-1:00pm, physical plant inspection was made.

Facility did not provide refund in a timely manner:
In regards to the allegation, it was reported that Resident 1 (R1) moved into the facility on 04/03/23, went ot the hospital 04/09/23, and never returned to the facility. Licensee was not given a specific reason why R1 will not be returning, other than a refund should be warranted. Interview with the administrator, confirms the duration of R1's stay. Administrator also confirmed that R1 was sent to the hospital, and was advised
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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-20230424105510
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: HILDA ASSISTED LIVING
FACILITY NUMBER: 197610345
VISIT DATE: 05/03/2023
NARRATIVE
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they will not be returning to the facility. Pursuant to the facility's admission agreement pertaining to refunds "If the resident does not provide the above 5-day notice the licensee shall refund a proportional daily amount of any prepaid monthly fee(s) within seven days from the date that the resident leaves the facility and the unit is vacated." The administrator stated the family advised him that they will retrieve R1's belongings, but they never did. From 04/10/23 to 04/20/23, R1's belongings remained, not allowing the administrator to advertise the room as vacant. LPA conducted a physical plant inspection to observe R1's belongings still being there. Based on the information obtained, there was insufficient evidence to confirm that licensee did not provide a refund in a timely matter as R1's belongings still remain at the facility. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff did not seek timely medical care for resident:
In regards to the allegation, it was reported that on 04/09/23, during a family visit, R1 was hot to touch. When family asked staff for assistance, staff did not respond. According to Staff 1 (S1), R1 was assessed, and their condition did not appear to be life-threatening at that time. S1 stated they called the administrator, who called R1's hospice agency. S1 did state, if R1's condition is life threatening, they would call 911 for emergency. According to the administrator, R1 was warm, but did not have a life threatening emergency. R1's hospice agency was called, and administrator was advised to provide R1 with Tylenol, and to continue to monitor any change in condition. Review of R1's hospice records indicate specific reasons why to call hospice, and administrator was following direction Administrator did state that he would call 911 if it appeared to be a life threatening situation and bypass calling hospice if it were an emergency. Although it was R1's family that called paramedics for non-emergency assistance, it still appeared that administrator did seek timely medical care by calling R1's hospice nurse and followed their instructions for a non-medical emergency in providing Tylenol and continued monitoring. Therefore, based on the information obtained, the allegation of staff not seeking timely medical care is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20230424105510
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: HILDA ASSISTED LIVING
FACILITY NUMBER: 197610345
VISIT DATE: 05/03/2023
NARRATIVE
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Facility forced resident to sign up for hospice:
In regards to the allegation, it was reported that R1 was enrolled in Hospice, but family was not consulted on R1's hospice enrollment. Administrator stated he had nothing to do with R1's enrollment into hospice. According to the administrator, R1 was referred to hospice by their primary physician during R1's stay at the hospital. Although hospice service was initiated after R1 was admitted into facility, R1 was already enrolled into hospice at the hospital, prior to discharge. Review of R1's records indicate the hospice care plan and service agreement was signed by R1's family. Based on the information obtained through interviews and record review, it could not be proven that the licensee forced R1 to sign up for hospice. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3