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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603495
Report Date: 10/06/2023
Date Signed: 10/06/2023 10:25:43 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/04/2022 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20220204161635
FACILITY NAME:AREGO HOME INCFACILITY NUMBER:
198603495
ADMINISTRATOR:MARKOSIAN, ARMENFACILITY TYPE:
740
ADDRESS:1017 WESTERN AVETELEPHONE:
(818) 913-1742
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:6CENSUS: 5DATE:
10/06/2023
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Marianna OhanyanTIME COMPLETED:
10:00 PM
ALLEGATION(S):
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Facility failed to properly evaluate the resident
Staff failed to provide adequate food service
Staff failed to provide activities for resident
Staff can’t communicate with residents due to language barrier
Staff failed to treat resident with respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent visit in order to deliver findings for the above-mentioned allegations. LPA met with Marianna Ohanyan and explained the reason for today's visit. Administrator arrived shortly after. The initial visit was conducted on 02/14/22.

The investigation consisted of the following: During initial visit, LPA inspected facility kitchen requested and received copies of pertinent documents related to complaint allegations. LPA interviewed total 5 residents (R2 - R6) and 5 staff (S1 - S5). During the investigation R1 was no longer in the facility.
During todays visit LPA obtained Residents and Staff roster and copies of R1 hospice care agreement.

Cont. 9099C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
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 4
Control Number 28-AS-20220204161635
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: AREGO HOME INC
FACILITY NUMBER: 198603495
VISIT DATE: 10/06/2023
NARRATIVE
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The investigation revealed the following:
Allegation - Facility failed to properly evaluate the resident. It was alleged that on November 2021, based on R1’s weaknesses, Resident #1 (R1) was enrolled in the hospice care without getting consent from POA.
At the time of this visit at 9:00 am LPA Margaryan inspected the facility, at 9:15 am LPA requested additional records, including R1’s hospice care agreement. The Administrator indicated that at the time of admission all records were signed by R1. Although, R1’s family member represented themselves as a POA, they never submitted any documents. Hospice agreement was signed by resident. A review of facility records verified the information received from the Administrator. All facility documents were signed by R1. A review of hospice records revealed that the hospice service agreement was also signed by R1 and R1’s evaluation for hospice services was completed by hospice personnel. During this investigation R1 was no longer in the facility.
Based on interviews and record review, there is no sufficient information or evidence to verify the allegation. Therefore, the allegation is unsubstantiated at this time.

Allegation - Staff failed to provide adequate food service. It was alleged that the facility failed to provide adequate food service for the residents. The food served to R1 was unhealthy as it didn’t contain any protein. During this investigation LPA inspected the facility kitchen and reviewed food supply.
On 02/14/2022 LPA observed resident eating lunch. The facility was serving sufficient quantity of well-balanced meal. Lunch consists of chicken w/fresh vegetables bread, and a beverage.
An interview of Administrator revealed that based on R1”s health condition, they required physicians approved special diet and the staff was following physician’s order. A review of R1’s records verified the information received from the Administrator.
Based on observation, interviews and record review, there is no relevant information to support the allegation. Therefore, the allegation is unsubstantiated at this time.

Cont. 9099C
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20220204161635
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: AREGO HOME INC
FACILITY NUMBER: 198603495
VISIT DATE: 10/06/2023
NARRATIVE
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Allegation - Staff failed to provide activities for resident. It was reported that the facility is not providing activities to R1.
During this investigation on 02/14/22, while visiting the facility before lunch time LPA observed residents engage in activities. One resident (R2) was watching TV and one resident (R3) was reading a book. In addition, on 02/16/2022, the administrator emailed photographic and videographic evidence of the activities, which clearly shows R1’s engagement to the activities. Interviews of staff and residents’ conducted during investigation indicated that facility is providing activities to the residents.
Based on observation, interviews and LPA’s review of the evidence provided by the Administrator, there is no pertinent information to support the allegation. Therefore, the allegation is unsubstantiated at this time.

Allegation - Staff can’t communicate with residents due to language barrier. It was alleged that facility staff couldn’t communicate with the residents due to a language barrier.
During this investigation on 02/14/2022, LPA spoke with the Administrator, staff and residents.
The Administrator was fluently communicating in English. He stated that caregivers may not be fluent. However, they are able to communicate with residents. All interviewed residents during visits had no concerns about staff communicating with them. At the time of visit, LPA spoke with staff, and observed them communicating with residents in English.
Based on observation and interviews, there is no sufficient information to corroborate with allegation. Therefore, the allegation is unsubstantiated at this time.

Cont. 9099C
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20220204161635
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: AREGO HOME INC
FACILITY NUMBER: 198603495
VISIT DATE: 10/06/2023
NARRATIVE
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Allegation - Staff failed to treat resident with respect.
It was alleged that the staff members were very mean towards R1 and were not taking care of them. The resident needed a chair while going in the shower and the facility failed to provide it to him.
During investigation R1 was no longer in the facility. The Administrator denied being disrespectful to R1 or any other resident. Residents interviewed at the facility stated that the staff is very respectful towards them. Interviewed residents did not witnessed staff being disrespectful to R1 or other residents.
During this investigation LPA spoke with caregivers who assisted R1 and they stated they always treated R1 with respect.
Based on observation and interviews there is no supporting information to verify the allegation. Therefore, the allegation is unsubstantiated at this time.

No immediate health and safety hazard is noted during this visit.
Exit interview was conducted, appeal rights were discussed, and a copy of report was issued.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4