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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610419
Report Date: 06/06/2024
Date Signed: 06/06/2024 07:45:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
06/02/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20240602100413
FACILITY NAME:ALL STAR CARE INCFACILITY NUMBER:
197610419
ADMINISTRATOR:DARABEDYAN, IVETAFACILITY TYPE:
740
ADDRESS:36240 52 ST EASTTELEPHONE:
(818) 624-6006
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:6CENSUS: 0DATE:
06/06/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Iveta DarabedyanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Residents were illegally evicted
Staff did not report facility status to the department
INVESTIGATION FINDINGS:
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On 06/06/2024 Licensing Program Analyst (LPA) Melissa Spaeth initiated a complaint investigation for the allegation(s) listed above and met with the Administrator Iveta Darabedyan. LPA Spaeth explained the purpose of this visit is to gather information regarding the complaint allegations. The Administrator confirmed there are currently no residents within the facility.

LPA Spaeth toured the facility at 10:00 am until 10:15 am and did not observe residents living in the facility, LPA Spaeth requested to review the following documents: 1) residents' documentation, and 2) residents' eviction notices. The Administrator stated they did not obtain all the required documentation when the residents moved into the facility. LPA interviewed the Administrator at 10:20 am until 11:30 am.

Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
06/02/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20240602100413

FACILITY NAME:ALL STAR CARE INCFACILITY NUMBER:
197610419
ADMINISTRATOR:DARABEDYAN, IVETAFACILITY TYPE:
740
ADDRESS:36240 52 ST EASTTELEPHONE:
(818) 624-6006
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:6CENSUS: 0DATE:
06/06/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Iveta DarabedyanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Residents were not allowed to decide what facilty they were relocated to
INVESTIGATION FINDINGS:
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Regarding the allegation, Residents were not allowed to decide what facility they were relocated to. R1, R2, & R3 stated they were not happy living at the facility. The Administrator found a licensed location which had rooms available. The Administrator presented the location to R1, R2, R3 with pictures and brochures. The Administrator stated spent time reviewing the information with the residents. The Administrator stated R1, R2, verbally stated they wanted to move to the location. R4 was happy with the location and did not want to move. On 4/19/2024, R4 was transferred to a hospital due to an illness. LPA spoke to R4's family member who stated R4 will be moved to a skilled nursing facility,
LPA spoke to the Administrator from the other facility location at 12:00 pm who stated R1 & R2 had moved out on 5/01/2024 to live with family members but R3 remained. LPA called the facility so speak to R3 but R3 was not available.

Based upon LPA's interviews, the allegation, residents were not allowed to decide what facility they were reloated to is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20240602100413
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ALL STAR CARE INC
FACILITY NUMBER: 197610419
VISIT DATE: 06/06/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation, residents were illegally evicted. It’s being alleged residents were not given a written 30-day eviction notice. The Administrator stated a verbal notice was given to all four residents but not a written notification.

Regarding the allegation, Staff did not report facility status to the department. It’s being alleged that the four residents (R1, R2, R3, and R4) were transferred to another licensed facility and the Administrator did not inform Community Care Licensing about the transfer. The Administrator stated R1, R2, and R3 were transferred to a licensed facility on 4/30/2024 because the residents were not happy. On 4/29/2024, R4 informed the Administrator they did not feel well and R4 was transferred to a local hospital. LPA Spaeth spoke to R4’s family member via phone call at 11:45 am who confirmed R4 was transferred to a local hospital. LPA asked if the Administrator had reported the transfer of residents to another facility to Community Care Licensing. The Administrator stated no.

Based upon the Administrator’s interview, the above allegations, residents were illegally evicted and staff did not report facility status to the department are substantiated.

Exit interview conducted, appeal rights discussed, and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20240602100413
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALL STAR CARE INC
FACILITY NUMBER: 197610419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2024
Section Cited
CCR
87224(a)
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Eviction Notification (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required....This is evidenced by:
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The Administrator will review regulation 87224 and send an email to LPA Spaeth confirming the Administrator did review the regulation
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Based upon LPA's interview of the Licensee, the licensee failed to issue a written thirty day written notice to the residents. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
06/07/2024
Section Cited
CCR
87211(a)(1)(D)
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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require…(1)A written report shall be submitted to the licensing agency…(D) Any incident which threatens the welfare, safety, or health of any resident…This is evidenced by:
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The Administrator will review regulation 87211 and send an email to LPA Spaeth confirming the Administrator did review the regulation
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Based upon LPA's interview of the LIcensee, the licensee failed to report to the Department that R1, R2, and R3 moved to another licensed facility and R4 was transported to the hospital
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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: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5