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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610483
Report Date: 11/05/2024
Date Signed: 11/05/2024 02:24:47 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
10/30/2024 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20241030162404
FACILITY NAME:LIFELONG SENIOR LIVINGFACILITY NUMBER:
197610483
ADMINISTRATOR:KAPIKYAN, ANDRANIKFACILITY TYPE:
740
ADDRESS:16003 LUDLOW STTELEPHONE:
(818) 371-5979
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 6DATE:
11/05/2024
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Lewis NdendeTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not prevent residents engaging in a physical altercation(s).
Staff handled resident in a rough manner.
Staff went through resident personal belongings without permission.
INVESTIGATION FINDINGS:
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Licensing Program Analsyt (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with staff, Lewis Ndende, and advised him of the allegations. Today's investigation consisited of a physical plant inspection, interviews with residents and staff, and record review.

Staff did not prevent residents engaging in a physical altercation:
In regards to the allegation, it was reported that on or around May 2024, Resident 2 (R2) became upset, and started hitting Resident 1 (R1) for no apparent reason. According to R1, there was staff, that intervened and broke up the incident, redirecting R2. It was also reported that on or around September 2024, as R1 was walking out of the bathroom, they were pushed by Resident 3 (R3). R1 did not sustain any injuries for either incidents. Interviews with staff deny the allegation of preventing residents from engaging in a physical altercation. Staff stated although you cannot really prevent an incident of this nature, they are trained to intervene and redirect. Interviews with five (5) of five residents could not corroborate with the allegation,
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
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 2
Control Number 31-AS-20241030162404
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: LIFELONG SENIOR LIVING
FACILITY NUMBER: 197610483
VISIT DATE: 11/05/2024
NARRATIVE
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stating they were unaware of either incidents, or have not witnessed either of the incidents. Based on the information obtained, although there was an altercation between R1 and R2, staff was present to intervene and redirect R2, possibly preventing injuries to either residents. Moreover, R1 confirmed there was staff intervention. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff handled resident in a rough manner:
In regards to the allegation, it was reported that on or around August and September 2024, R2 was heard yelling at staff that they were "being to rough", while assisting R2 in the shower. There were no witnesses identified to confirm the allegation. Interviews with staff deny the allegation. Interviews with five (5) residents could not corroborate that this allegation has occurred. Based on the information obtained, there was insufficient evidence to prove staff handled R2 in a rough manner. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff went through resident personal belongings without permission:
In regards to the allegation, it was reported that staff went through R1's toiletry bag while R1 was in the restroom. There was nothing reported missing. R1 just stated they normally zip their bag close, but when checked, zipper was open. Interviews with staff deny the allegation. Interviews with the five (5) other residents could not corroborate with the allegation, stating they haven't encountered an incident similar to this with staff. These residents had no complaints about safekeeping their personal belongings. Based on the information obtained, there was insufficient evidence to prove that staff went through R1's personal belongings without permission. Therefore, the allegation is deemed Unsubstantiated at this tiime.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2