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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610429
Report Date: 12/11/2024
Date Signed: 12/11/2024 06:38:20 PM

Substantiated


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
12/05/2024 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20241205141612
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: 3DATE:
12/11/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karine Sarkisyan, Administrator TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff do not provide quality meals to resident(s)
INVESTIGATION FINDINGS:
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At 9:00am, Licensing Program Analyst (LPA) Angela Panushkina and Regional Director, LTC Ombudsman Program, Ginger Perini, conducted an unannounced initial 10-day complaint investigation regarding the above allegation. The team met with staff, Chinara Atamkulova, who granted access to the facility. Administrator arrived shortly after, and the team explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 09:05am, LPA requested resident and staff roster. At 10:10am, LPA requested copies of pertinent information which include, but not limited to Preplacement Appraisal Information, and Facility Menu, relevant to the investigation. At approximately 09:15am, 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 09:20am – 12:30pm, LPA interviewed the Administrator, one (1) staff, and three (3) residents. Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
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 3
Control Number 31-AS-20241205141612
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: 12/11/2024
NARRATIVE
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Allegation: Facility staff do not provide quality meals to resident(s)

It was alleged that the facility staff do not provide quality meals to resident(s). To investigate this allegation, the team reviewed the menu and the food supply with the staff. The staff was interviewed regarding the meal plan for the day. The facility has two refrigerators and the food supply was checked. The team observed that there were eggs, milk, fruits and vegetable as part of the perishable foods. However, the team did not observe the freezer stocked with adequate perishable foods: a chicken, beef, pork nor fish. The Administrator informed the team that she will do shopping today. Lastly, at 10:15am, the team observed S1 prepared only half (½) grilled cheese with 6oz of orange juice for R2's breakfast. Based on interviews and observation this allegation is Substantiated.

Deficiencies issued per Title 22.
Exit interview conducted appeal rights explained and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20241205141612
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/13/2024
Section Cited
CCR
87555(a)
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General Food Service Requirements. (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... All food shall be.. prepared and served in a safe and healthful manner...
This requirement is not met as evidenced by:
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Licensee/Administrator shall develop a plan to ensure facility will maintain sufficient food supply at all times. Submit plan and additional food supply purchased by POC date
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Based on LPAs' inspection and observation, licensee did not comply with the section cited above by preparing a small portion of grilled cheese and orange juice for breakfast, this poses a potential health, safety 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: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3