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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610474
Report Date: 11/12/2024
Date Signed: 11/12/2024 12:40:36 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
11/04/2024 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20241104152029
FACILITY NAME:LINDLEY RESIDENTIAL CAREFACILITY NUMBER:
197610474
ADMINISTRATOR:AVETISYAN, ARMENUHIFACILITY TYPE:
740
ADDRESS:18126 W VINTAGE STREETTELEPHONE:
(818) 983-2224
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:6CENSUS: 3DATE:
11/12/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Larisa BobakovaTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Licensee did not post ombudsman program information as required by law
INVESTIGATION FINDINGS:
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On 11/12/24, at 12:00pm, Licensing Program Analysts (LPAs) Gina Saucedo and Angelica Segovia arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Lead Caregiver Larisa Bobakova. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, conduct staff and resident interviews and deliver findings for this complaint.

The investigation consisted of the following: LPAs asked for the census, requested the staff and resident roster. At 12:10pm, LPA toured the physical plant. During the tour, residents and staff were interviewed.

9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

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

DATE: 11/12/2024
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-20241104152029
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: LINDLEY RESIDENTIAL CARE
FACILITY NUMBER: 197610474
VISIT DATE: 11/12/2024
NARRATIVE
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Regarding the allegation: Licensee did not post ombudsman program information as required by law. It is being alleged that the LTCOP (long term care ombudsman program) poster was given to the above facility, and it was not posted. At the time of the LPA’s visit, the LTCOP (long term care ombudsman program) poster was posted on the right side of the entrance of the facility against the wall. LPA took pictures of the LTCOP (long term care ombudsman program) poster. LPA interviewed two (2) staff and confirmed that it was given to them in September, they signed a paper that it was given to them, and they posted it immediately. LPA interviewed two (2) residents that confirmed the poster has been posted where it currently is. Therefore, based on the LPA's record reviews, staff and resident interviews the above allegation(s) above is UNSUBSTANTIATED at this time.



An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Lead Caregiver.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

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

DATE: 11/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2