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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603127
Report Date: 07/11/2022
Date Signed: 07/11/2022 02:57:43 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, 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
07/05/2022 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220705141921
FACILITY NAME:ALAMEDA BOARD & CAREFACILITY NUMBER:
198603127
ADMINISTRATOR:AVETISYAN, ARMENUHIFACILITY TYPE:
740
ADDRESS:1129 ALAMEDA AVETELEPHONE:
(213) 595-2777
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:6CENSUS: 6DATE:
07/11/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Vahag AmirjanyanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not ensure a safe and healthy environment by speaking inappropriately to a resident
Staff would not allow resident to have personal property
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Licensee Vahag Amirjanyan and explained the reason for the visit.

The Investigation consisted of the following: LPA conducted interviews with Licensee Vahag Amirjanyan, Administrator Yelena Amirjanyan, Staff 1-2 (S1-2), Residents 1-3 (R1-3) and Kern Medical Emergency Department LVN Discharge Facilitator (LVN DF) by telephone. LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file and collected copies of the following: Physician's Report for Residential Care Facilities for the Elderly dated 1/10/22, Identification and Emergency Information dated 2/4/21, Preplacement Appraisal Information dated 2/5/21, Resident Appraisal dated 2/5/21, Appraisal/ Needs and Services Plan dated 2/1/21, Kern Medical Emergency Department Discharge Instructions dated 7/3/22, Unity First Hospice Care Inc paperwork, Note signed by R1 dated 7/7/22 and Note signed by R1's

(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
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 3
Control Number 28-AS-20220705141921
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: ALAMEDA BOARD & CARE
FACILITY NUMBER: 198603127
VISIT DATE: 07/11/2022
NARRATIVE
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Family Member (R1 FM) regarding personal belongings dated 6/30/22. LPA additionally conducted a tour of facility which included observations of living room, dining room, kitchen and random resident rooms which included R1's room. LPA attempted a phone call to Unity First Hospice Care Inc.

Investigation revealed the following: Regarding allegation, Staff did not ensure a safe and healthy environment by speaking inappropriately to a resident, it is alleged that facility staff made inappropriate comments to a facility resident and that facility is not providing appropriate physical care to a resident as prescribed. Interviews conducted with facility licensee Mr. Amirjanyan and Administrator Yelena Amirjanya revealed that facility staff provide a safe and healthy environment to all facility residents at all times. They denied that any facility staff have ever spoken inappropriately to any facility resident and stated that staff take very good care of all facility residents at all times. Interviews conducted with S1-2 revealed that staff ensure a safe and healthy environment for all residents at all times and provide the appropriate needed care that each facility resident needs. S1-2 denied ever making any inappropriate comments or speaking inappropriately to any facility resident and stated that they treat all facility residents with dignity and respect at all times. 3 out of 3 residents that were interviewed stated that they are happy at the facility and stated that facility have not spoken to them inappropriately. 3 out of 3 residents stated that they are happy at the facility, feel safe at the facility and do not have any concerns. Interview with R1 revealed that they are happy at the facility and they live at the facility due to their personal choice. LPA observed staff interactions with facility residents and observed staff tending to residents and speaking to them in an appropriate manner. Based on interviews conducted with facility staff, facility residents, and LPA observations, there was not enough supportive evidence to concur with the reported allegation.

Regarding allegation, Staff would not allow resident to have personal property, it is alleged that facility staff did not allow resident to take their wheelchair and oxygen machine. Interviews conducted with Licensee Mr. Amirjanyan and Administrator Yelena Amirjanya revealed that R1 FM came to the facility on 6/30/22 and chose to independently remove R1 from the facility to individually care for and take responsibility for R1. R1 agreed to leave with R1 FM and took all their belongings. R1 FM signed a letter indicating that they were taking full responsibility of R1 and was taking all of R1's belongings including all medications. They stated that the only items that the facility did not allow R1's FM to take were the wheelchair and oxygen machine due to the items being property of Unity First Hospice Care Inc and assigned to R1 as Durable Medical Equipment (DME) for use at the facility and R1 FM was relocating R1 to a different county in California. LPA
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220705141921
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: ALAMEDA BOARD & CARE
FACILITY NUMBER: 198603127
VISIT DATE: 07/11/2022
NARRATIVE
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reviewed Unity First Hospice Care Inc paperwork and observed that both items are listed as DME equipment. LPA attempted to contact hospice agency but was not able to reach anyone. LPA also reviewed Note signed by R1FM which listed R1's belongings that were taken on 6/30/22. Interviews conducted with R1-3 revealed that they do not have any concerns regarding their personal property and they stated that they do not have any concerns regarding the facility or the services received at the facility. R1 stated that they want to live at the facility and no longer wish to live with R1 FM. Interview conducted with Kern Medical Emergency Department LVN DF revealed that R1 was left at the hospital by R1 FM due to R1 FM not being able to care for R1 and did not leave any belongings for R1. LVN DF stated that R1 did not have a medical reason to be left at the hospital and stated that R1 told them that they wanted to return to the facility. R1 was transferred from the hospital back to the facility with no belongings as R1 FM left R1 at the hospital with no belongings. LPA toured the facility including R1's room and did not observe anything of concern. Administrator stated that R1 FM came to the facility on 7/10/22 and dropped off some of R1's belongings. Based on interviews conducted with facility staff, facility residents, Kern Medical Emergency Department LVN DF, LPA observations, and LPA review of records, there was not enough supportive evidence to concur with the reported allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to Licensee Vahag Amirjanyan.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Alma Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3