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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610429
Report Date: 06/05/2024
Date Signed: 06/05/2024 04:58:16 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.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
05/31/2024 and conducted by Evaluator Leslie Ngo-Castaneda
COMPLAINT CONTROL NUMBER: 31-AS-20240531162143
FACILITY NAME:SIMPLE TOUCH BOARD AND CARE INCFACILITY NUMBER:
197610429
ADMINISTRATOR:SARKISYAN, KARINEFACILITY TYPE:
740
ADDRESS:22317 MOBILE STTELEPHONE:
(747) 444-8506
CITY:CANOGA PARKSTATE: CAZIP CODE:
91303
CAPACITY:6CENSUS: 1DATE:
06/05/2024
UNANNOUNCEDTIME BEGAN:
08:19 AM
MET WITH:SARKISYAN, KARINE- administratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Licensee does not ensure that staff follow food safety protocols.
Staff do not ensure that resident's room is sanitary.
INVESTIGATION FINDINGS:
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Licensing Program Manager(LPM) Nichelle Gillyard and Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at 8:20 am and met with the Administrator Karine Sarkisyan. The Administrator was informed of the reason for the visit.

Entrance interview conducted.

LPA/LPM conducted interviews with staff, attempted to interview resident in care and attempted to review records. LPA/LPM conducted a food inspection tour and a physical plant tour.

Allegation: Licensee does not ensure that staff follow food safety protocols.

Continue to LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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 4
Control Number 31-AS-20240531162143
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: SIMPLE TOUCH BOARD AND CARE INC
FACILITY NUMBER: 197610429
VISIT DATE: 06/05/2024
NARRATIVE
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The complainant’s concern was that the licensee left food sitting out on the table for hours. While this was not observed and there were no other witnesses to cooperate the specifics of this allegation there were other food safety protocols not followed.

At approximately 8:45 am LPA/LPM toured the kitchen area and initiated food service inspection. LPA/LPM observed an incontinent pad on the top shelf of the refrigerator to catch any spills from the shelf. Foods which include packs of hot dogs, cans of tomatoes sauce and a pot with a quarter red tomato and remnants of rice in a pan were observed to not be appropriately sealed and wrapped appropriately to protect from contamination. LPA/LPM observed a can of bug spray stored with potatoes and cooking pots under the kitchen sink. Therefore, after review of the information gathered the allegation, “Licensee does not ensure that staff follow food safety protocols” is substantiated. Deficiency issued.

Allegation: Staff do not ensure that resident’s room is sanitary.

The complainants concern that soiled depends(adult diapers) were left in the room for a lengthy period of time. While this was not observed and there were no other witnesses to cooperate the specifics of this allegation, LPA/LPM observed other sanitary issues which include two (2) half-full plastic portable urinals sitting on a table by the resident. This is a health and safety issue should the urinals falls spilling the urine. LPA/LPM observed a urine-stained mattress in an unoccupied room #1. LPA/LPM observed an ant infestation on top of an old plate with crumbs of food in room #4. The ant infestation was observed to also be within the residents clothing box. Therefore, after review of the information gathered the allegation, “Staff do not ensure that resident's room is sanitary”, is substantiated. Deficiency issued.


Administrator was advised and a copy of this report given.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20240531162143
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: SIMPLE TOUCH BOARD AND CARE INC
FACILITY NUMBER: 197610429
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2024
Section Cited
CCR
87555(28)
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All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement is not met as evidenced by LPM/ LPA observe checmicals to be stored under the kitchen sink with food, which poses a potential health
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Harmful chemical/ poison that is located under the kitchen sink needs to be removed. Food and chemicals needs to be stores seprately. Food (sack of patatoes) under the sink needs to be discarded.
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 safety or personal rights risk to persons in care. This requirement is not met as evidenced by LPM/ LPA observed harmful chemicals/poison to be stored together with food under the sink.
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Type A
06/05/2024
Section Cited
CCR
87555(24)
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Pesticides and other toxic substances shall not be stored in food storerooms, kitchen areas, or where kitchen equipment or utensils are stored.This requirement is not met as evidenced by LPM/ LPA observe checmicals to be stored under the kitchen sink with food, which poses a potential health
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Harmful chemical/ poison that is located under the kitchen sink needs to be removed and tuck away in a lock area.
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safety or personal rights risk to persons 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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4