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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610458
Report Date: 07/18/2024
Date Signed: 07/18/2024 02:13:58 PM

Unsubstantiated


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
07/16/2024 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20240716084315
FACILITY NAME:ECLIPSE SENIOR CAREFACILITY NUMBER:
197610458
ADMINISTRATOR:DISHOYAN, NERSESFACILITY TYPE:
740
ADDRESS:7045 BECKFORD AVENUETELEPHONE:
(818) 578-8933
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 3DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Armine Dishoyan, DesigneeTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff would not allow authorized representative to use hospice company of choice
INVESTIGATION FINDINGS:
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At 09:00 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced initial complaint visit. LPA met with Staff #1 (S1) who could not communicate in English and LPA contacted the Administrator via telephone and informed them of the visit. LPA was provided access to the facility and shortly after the Designee Armine Dishoyan, arrived and LPA disclosed the reason for the visit.

During course of the investigation, interviews and record review were made. At 09:35 AM, LPA requested resident and staff roster. At 9:45 AM, LPA requested copies of pertinent information which include, but not limited to Physician’s Report, Appraisal Needs and Services Plan, Hospice file, Admission Agreement and, etc., relevant to the investigation. At approximately 10:00 AM, LPA conducted a physical plant tour. Between 10:30 AM – 1:30 PM, LPA conducted an interview with the Administrator, An Officer of Los Angeles Police Department, One (1) out of three (3) residents who was able to communicate, and a family member of a resident.
Continue on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 2
Control Number 31-AS-20240716084315
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: ECLIPSE SENIOR CARE
FACILITY NUMBER: 197610458
VISIT DATE: 07/18/2024
NARRATIVE
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Staff would not allow authorized representative to use hospice company of choice:
It was alleged that the residents are forced to sign up with certain Hospice and Palliative care in order to be enrolled in the facility. To investigate this allegation LPA conducted an interview with the Designee and LPA was informed that the facility has a list of four (4) to five (5) Hospice and Palliative care agencies that they work with. The facility provides choices of Hospice and Palliative care to the residents or Power of Attorney (POA) of the residents to choose. Furthermore, LPA was informed that if a resident or the POA chooses an Hospice and Palliative care of their own choice they are allowed to do so and there are no restrictions. At 1:30 PM, LPA contacted an Hospice Director of Nurses who confirmed that the facility provides at least three options to resident and their families for the services and the final agreement is always being signed by a family member of a resident or a resident themselves. Lastly, interview with one (1) out of three (3) residents who was able to communicate and a POA of a resident confirmed the information and did not have any concerns regarding the above allegation. Based on interviews, file reviews, and LPA's observation/inspection this allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2