198603555-8-17-2023-28-AS-LHIS-CV5KWX-20230828081640

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603555
Report Date: 08/17/2023
Date Signed: 08/17/2023 04:17:48 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
08/14/2023 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230814181129

FACILITY NAME:	CIRCLE OF GRACE, INC.		FACILITY NUMBER:	198603555
ADMINISTRATOR:	KHACHATRYAN, ANNA		FACILITY TYPE:	740
ADDRESS:	7157 HIDDEN PINE DR		TELEPHONE:	(818) 425-6797
CITY:	SAN GABRIEL	STATE: CA	ZIP CODE:	91775
CAPACITY:	6	CENSUS: 6	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	11:11 AM
MET WITH:	Nvard Gevorkian, Licensee		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff does not ensure residents have access to receive telephone calls.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit in regards to the allegation listed above. LPA discussed the purpose of the visit with staff Diana Castellanos. Licensee Nvard Gevorkian arrived later and Administrator Anna Khachatryan was contacted telephonically.

The investigation consisted of: A tour of the interior and exterior physical plant was conducted, with focus on landline telephone access/communication. Staff (S1- S4) and family members (F1- F5). Interviews with residents were attempted, but due to cognitive impairment due to Dementia no residents were interviewed. Resident (R1-R6's) Identification and Emergency Information face sheets were obtained, as well as R1's Conservatorship and Durable Power of Attorney documents, Physician's Report, LIC 500 Personnel Report, and Register of Facility Residents.

***See narrative summary on next page.***

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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 28-AS-20230814181129

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: CIRCLE OF GRACE, INC.	FACILITY NUMBER: 198603555
	VISIT DATE: 08/17/2023

NARRATIVE

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Allegation: Staff does not ensure residents have access to receive telephone calls. It is alleged that resident's relatives attempt to call the facility multiple times (up to 15) phone calls in order for staff to answer the phone and/or they do not answer at all. According to staff interviews, residents are always given the phone when family call, unless the residents are sound asleep. Which in that case, the callers are asked to call back later. A total of four (4) staff were interviewed, all denied the allegation and stated that staff always answer the land line phone. Per staff, resident (R1) receives frequent phone calls from one of their adult children, and are always passed to R1. LPA called resident's responsible parties, of which the majority stated they do not have issues with accessing their loved one via telephone calls when desired and receive immediate communication and/or call backs from staff. However, four (4) out of the five (5) family members interviewed stated they never call the land line telephone because their loved ones have Dementia and are unable to communicate. The primary mode of communication is through the Administrator's cell phone, facility staff, or in person visits.

During the course of the investigation, LPA learned that resident (R1) has a conservator that asked Administration staff not to pass phone calls to resident (R1) if one of their adult children calls, but it is not specified by the court order. This issue is being addressed in a separate case management report. Due to cognitive impairment no resident interviews were conducted. There are two land line telephones in the facility, one in the kitchen and one in the living room. The land line telephone line was tested and is found to be operational. There is insufficient evidence to proved the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted with staff Diana Castellanos. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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