197610483-1-29-2025-31-AS-EMIR-DEH2G6-20250305162237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610483
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:06:54 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
12/18/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20241218081847

FACILITY NAME:	LIFELONG SENIOR LIVING		FACILITY NUMBER:	197610483
ADMINISTRATOR:	KAPIKYAN, ANDRANIK		FACILITY TYPE:	740
ADDRESS:	16003 LUDLOW ST		TELEPHONE:	(818) 371-5979
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 6	DATE:	01/29/2025
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Lewis Ndende, Nsikeloelo Masuloa		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not ensure meals provided to the residents consist of an appropriate variety of foods
Staff involuntarily transferred resident to a separate facility room

INVESTIGATION FINDINGS:

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In conjunction with complaint control # 31-AS-20240822103213 and a Required Annual inspection, Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. LPA met with staff Lewis Ndende and Nsikeloelo Masuloa, and advised them of the complaint. The initial visit was made by LPAs Cava and Nadia Shahbazian on 12/20/24. LPA Cava’s investigation consisted of interviews with staff and residents. LPA also conducted a physical plant inspection and record review.

Staff did not ensure meals provided to the residents consist of an appropriate variety of foods:
In regards to the allegation, no indication was made about foods not consisting of an appropriate variety, but it was reported that food prepared caused a resident to become ill. Interviews with staff deny the allegation. Staff adds they haven’t experienced or witness the residents feel ill from meals that were served. No reports made to the health department regarding any food poisoning. Interviews with six (6) of six residents do

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

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-20241218081847

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: 01/29/2025

NARRATIVE

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not corroborate with the allegation. In addition to interviews, LPA made a physical plant inspection of the kitchen and food supply and observed a variety of perishable and non-perishable food on stock. Based on the information obtained, there was insufficient evidence to prove that staff do not ensure meals provided to residents consist of an appropriate variety. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff involuntarily transferred resident to a separate facility room:
In regards to the allegation, it was reported that Resident 1 (R1) was involuntarily moved from their private room to a non-private room. R1’s responsible person was not notified of this, and because R1 is non-verbal, R1 could not have given consent for the move on their own. The complaint report also indicated that the private room is now occupied by a female resident. There is no clear explanation on why there was a room change. Moreover, it could not be confirmed if the Admission Agreement (AA)specified a private room would be provided to R1.

Interviews with administrator and staff deny the allegation. At admission, R1 and the responsible person was notified of the shared room that R1 will be residing in. There were no room changes made. Room assigned was what was agreed upon. LPA conducted a review of R1’s AA and observed that private room service was declined, opting for the basic rate. Based on the information obtained, there was insufficient evidence to corroborate the allegation of R1 being involuntarily moved to a separate facility room. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC9099 (FAS) - (06/04)

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