197610429-9-25-2024-31-AS-NGID-D9TTD7-20241007143748

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610429
Report Date: 08/02/2024
Date Signed: 09/25/2024 03:28:15 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
05/31/2024 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20240531162143

FACILITY NAME:	SIMPLE TOUCH BOARD AND CARE INC		FACILITY NUMBER:	197610429
ADMINISTRATOR:	SARKISYAN, KARINE		FACILITY TYPE:	740
ADDRESS:	22317 MOBILE ST		TELEPHONE:	(747) 444-8506
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91303
CAPACITY:	6	CENSUS: 2	DATE:	08/02/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Karine Sarkisyan, Administrator		TIME COMPLETED:	12:04 PM

ALLEGATION(S):

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Licensee does not ensure that staff are present at the facility while residents are in care.
Staff did not seek medical attention for resident in a timely manner.
Licensee does not ensure that residents are provided with food that is of the quality and in the quantity necessary to meet their needs.

INVESTIGATION FINDINGS:

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At 10:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent visit at this facility to investigate the above allegations. LPA met with the Administrator and explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 10:05am, LPA requested resident and staff roster. At 10:10am, LPA attempted to request copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, relevant to the investigation. At approximately 10:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:20am – 12:30pm, LPA interviewed the Administrator, one (1) staff and (two) out of two (2) residents.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

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-20240531162143

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: SIMPLE TOUCH BOARD AND CARE INC	FACILITY NUMBER: 197610429
	VISIT DATE: 08/02/2024

NARRATIVE

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Allegation: Licensee does not ensure that staff are present at the facility while residents are in care.

It was alleged that the facility Administrator with the spouse (Staff #1) go home at night and no staff are present to provide care to the residents. To investigate this allegation, LPA conducted an interview with the Administrator and S1 and both denied the above allegation. LPA was informed that although the facility has a night shift staff, the Administrator and S1 do not leave the facility premises due to residing at the facility and mostly stay in their room. Two (2) out of two (2) residents interviewed corroborated with the Administrators statement and expressed no concerns regarding this allegation. Lastly, during the physical plant tour, LPA observed the staff room with a private kitchen/dining area and a bathroom available. Based on LPA's observations and interviews this allegation is deemed Unsubstantiated, at this time.

Allegation: Staff did not seek medical attention for resident in a timely manner.

It was alleged that R1 fell and hurt his/her back, arms and legs (bruising) and the Administrator refused to call 9-1-1. To investigate this allegation, LPA conducted an interview with the Administrator and S1. Both parties interviewed informed LPA that R1 did not have a fall. LPA was informed that on 05/07/24, R1 went out for lunch with friends. Administrator also informed LPA that once R1 came back to the facility, R1 went into his/her room. When Administrator went to check on R1, he/she was walking towards the Administrator with the walker and told the Administrator that his/her legs are giving up. At that point, the Administrator called S1 for help and held R1. R1 slowly was able to seat on the floor. LPA was informed that there was no incident of a fall. Few minutes later, R1 felt better and was placed on a bed. Interview with the Administrator also revealed that although R1's hospice nurse was immediately contacted and R1 was evaluated on that same day, 9-1-1 was called on 05/13/24, due to R1's decline in condition. In addition, Administrator and S1 informed LPA that prior to their employment they completed 40 hours of training, and they are aware of the proper steps on how to assist residents with their medical needs, they immediately contact hospice or emergency services, if needed. Interview with two (2) out of two (2) residents revealed that they feel very safe living at this facility. Both residents also informed LPA that the facility staff is very professional and knowledgeable of their duties. Lastly, review of R1's Medical Records revealed that R1 was diagnosed with atelectasis/pneumonia, and no evidence of bruising nor serious injury were observed upon admission. Based on interviews and record reviews this allegation is deemed Unsubstantiated, at this time.
Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SIMPLE TOUCH BOARD AND CARE INC	FACILITY NUMBER: 197610429
	VISIT DATE: 08/02/2024

NARRATIVE

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Allegation: Licensee does not ensure that residents are provided with food that is of the quality and in the quantity necessary to meet their needs.

It was alleged that facility staff failed to provide adequate food service. To investigate this allegation, LPA conducted a physical plant walk through at 10:15am and observed the refrigerator to be fully stocked. Additionally, LPA observed lunch being prepared for the residents, and it was observed to be nutritious. Lastly, LPA conducted interviews with two (2) out of two (2) residents and both residents stated they were happy with the food services and meals they are provided. Based on LPA's observations and interviews, this allegation is deemed Unsubstantiated, at this time.

No deficiency cited during today's visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

LIC9099 (FAS) - (06/04)

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