<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603100
Report Date: 05/19/2021
Date Signed: 05/19/2021 04:14:46 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2021 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20210514160623
FACILITY NAME:NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLCFACILITY NUMBER:
198603100
ADMINISTRATOR:TOPADZUIKYAN, EMMAFACILITY TYPE:
740
ADDRESS:1444 WESTERN AVETELEPHONE:
(818) 245-6614
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:5CENSUS: 5DATE:
05/19/2021
UNANNOUNCEDTIME BEGAN:
01:49 PM
MET WITH:Emma Topadzuikyan - Administrator TIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not wearing face coverings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst(s) Mary Flores and Luis Mora conducted a complaint investigation regarding the above allegations. LPA(s) met with Emma Topadzuikyan, Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA(s) conducted a tour of the facility at 2:00pm with Administrator, LPA observed three (3) resident bedrooms, four (4) bathrooms, living room, kitchen/dining room, outdoor back patio and front yard, as well as interviewed residents #1,#2,#3,#4,#5 (R1,R2,R3,R4,R5) and staff #1,#2(S1,S2)

The investigation revealed the following: Regarding allegation: Staff not wearing face coverings. It is alleged facility care staff does not wear face coverings on a daily basis. Upon arriving at the facility LPA(s) observed staff #2 walk from the kitchen through the living room R2 was sitting in a chair between the kitchen and the living room and approached the door without a face covering. During interviews 2 out of 5 residents stated that staff wear a face covering at all times when working around residents. (CONTINUED LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
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 5
Control Number 28-AS-20210514160623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC
FACILITY NUMBER: 198603100
VISIT DATE: 05/19/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
1 out of 5 residents stated that staff only wear a face covering when strangers come into the facility and 2 out of 5 residents were unable to answer interview due to cognitive skills. 2 out of 2 staff stated that they wear mask at the facility while providing care for residents.

Based on LPA's observation, interviews conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099C.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2021 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20210514160623

FACILITY NAME:NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLCFACILITY NUMBER:
198603100
ADMINISTRATOR:TOPADZUIKYAN, EMMAFACILITY TYPE:
740
ADDRESS:1444 WESTERN AVETELEPHONE:
(818) 245-6614
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:5CENSUS: 5DATE:
05/19/2021
UNANNOUNCEDTIME BEGAN:
01:49 PM
MET WITH:Emma Topadzuikyan - Administrator TIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is unkempt
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst(s) Mary Flores and Luis Mora conducted a complaint investigation regarding the above allegations. LPA(s) met with Emma Topadzuikyan, Administrator.

The investigation consisted of the following: LPA(s) conducted a tour of the facility at 2:00pm with Administrator, LPA observed three (3) resident bedrooms, four (4) bathrooms, living room, kitchen/dining room, outdoor back patio and front yard, as well as interviewed residents #1,#2,#3,#4,#5 (R1,R2,R3,R4,R5) and staff #1,#2(S1,S2)

The investigation revealed the following: Regarding allegation: Facility is unkempt. It is alleged facility has mattresses, toilets, and furniture out on the front lawn every other week. During the tour LPA(s) observed facility to be clean and free of debris inside, as well as back patio and front yard. LPA(s) observed a twin mattress and box on the sidewalk in front of the facility. During interviews 3 out of 5 residents stated that staff clean the facility daily and not to have observed debris outside the facility. (CONTINUED LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20210514160623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC
FACILITY NUMBER: 198603100
VISIT DATE: 05/19/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
2 out of 5 residents were unable to answer interview due to cognitive skills. Interview with administrator determined that they dispose of broken furniture at least every six months and prior to placing furniture outdoors facility contacts the city. Regarding mattress observed outside administrator has called the city and pick up is schedule for 5/25/21.

Based on LPA's observation, interviews conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20210514160623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: NO PLACE LIKE HOME FOR GOLDEN AGES 2 LLC
FACILITY NUMBER: 198603100
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2021
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
87468.1(a)(2) Personal Rights of Residents in all Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirements is not met as evidence by:
1
2
3
4
5
6
7
Administrator will provide in-service training with staff regarding residents personal rights and COVID guidelines and recommendations regarding face covering, and proper wearing of face covering by 5/20/21.
8
9
10
11
12
13
14
Based on observation on 5/19/21 licensee failed to protect the personal rights of clients in care to receive safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of clients in care, in the facility staff #2 faided to wear face coverings while providing care and supervision to residents in care in violation of
8
9
10
11
12
13
14
official government orders requiring the wearing of face coverings while working under specified conditions.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Rebecca Orendain
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5