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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603515
Report Date: 11/21/2023
Date Signed: 12/04/2023 04:43:53 PM

Document Has Been Signed on 12/04/2023 04:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TOUCHING HEARTS BOARDING CAREFACILITY NUMBER:
198603515
ADMINISTRATOR:MKRTCHYAN, MARGARITAFACILITY TYPE:
740
ADDRESS:1010 LINDEN AVETELEPHONE:
(424) 216-0864
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 6CENSUS: 5DATE:
11/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Margarita Mkrtchyan, AdministratorTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Rosaura Valenzuela and Antonia Avizar conducted an unannounced Case Management visit in conjunction with complaint control number 31-AS-2023110113303. The purpose of this Case Management visit is to issue citations for deficiencies observed during the course of the complaint investigation that is not directly related to the complaint. LPAs met with Margarita Mkrtchyan, Administrator.

During the investigation, LPA Valenzuela observed the following:

1) There is an employee present that is not fingerprint cleared.

2) Administrator lacking qualifications.

3) Administrator did not notify that a resident had entered into hospice care.

4) No copy of the written certification statement from resident's terminal illness doctor from hospice.

Pursuant to the California Code of Regulations, Title 22, the following deficiencies were observed and cited during this visit.

Exit interview conducted, a copy of the report and citations were issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/05/2024 09:39 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/01/2023 01:53 PM


Created By: Rosaura Valenzuela On 11/21/2023 at 02:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TOUCHING HEARTS BOARDING CARE
FACILITY NUMBER: 198603515

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/05/2023
Section Cited
CCR
87411(g)

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87411(g) Personnel Requirements-General-Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: 1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations.
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The Licensee will request a criminal record excemption for the uncleared employee or will terminate the employee effective immediately.
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This requirement was not met as evidenced by: Based on observation and records review, the Licensee hired an employee who was not fingerprint cleared. This poses an immediate health and safety risk to residents in care.
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Type B
12/05/2023
Section Cited
CCR87405(d)(2)

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87405 (d)(1)(2) Administrator Qualifications and Duties-The administrator shall have the qualifications specified in Sections 97405(d) (1) through (7)..(2) Knowledge of the ability to conform to the applicable laws, rules, and regulations...
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The administrator will enroll and take more administrator courses and provide proof of enrollment to CCLD by Dec. 5, 2023.
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This requirement was not met as evidenced by: Licensee did not ensure that the Administrator has enough knowledge to comply with Title 22 Regulations. Based on interview and record review, the facility is not in compliance with Title 22 Regulations.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Naira Margaryan
LICENSING EVALUATOR NAME:Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023


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Document Has Been Signed on 11/21/2023 04:18 PM - It Cannot Be Edited


Created By: Rosaura Valenzuela On 11/21/2023 at 02:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TOUCHING HEARTS BOARDING CARE
FACILITY NUMBER: 198603515

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2023
Section Cited
CCR
87211(a)(1)(B)

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87211(a)(1)(B) Reporting Requirements-(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(1) A written report shall be submitted to the licensing agency for (B) any serious injury as determined by the attending physician and occuring while the resident is
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The licensee shall submit in writing to the Department by Dec. 5, 2023, how they will ensure that all reports pertaining to the residents health, injury, or death will be sent to licensing in a timely manner.
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under facility supervision.
This requirement was not met as evidenced by: The licensee did not notify the Department that a resident had entered hospice care. This poses a potential health and safety risk to residents in care.
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Type B
11/21/2023
Section Cited
CCR87633(h)(3)

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87633(h)(3)-Hospice Care of Terminally Ill Residents (h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record (3) A copy of the written certification statement of the resident's terminal illness from the medical director of hospice...
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The licensee shall submit in writing by Dec.5, 2023, how they will ensure that residents in hospice have complete hospice records.
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This requirement was not met as evidenced by:
The licensee did not provide the Department representative with this documentation. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Naira Margaryan
LICENSING EVALUATOR NAME:Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023


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