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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700545
Report Date: 01/29/2025
Date Signed: 01/29/2025 10:27:17 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2025 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 59-AS-20250113142420
FACILITY NAME:BETHESDA SENIOR CAREFACILITY NUMBER:
342700545
ADMINISTRATOR:BOSTANCHYAN, DAVIDFACILITY TYPE:
740
ADDRESS:8874 NIMBUS WAYTELEPHONE:
(916) 627-0305
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 6DATE:
01/29/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Jacob BostanchyanTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility is trying to evict resident illegally.
INVESTIGATION FINDINGS:
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On 01/29/25, Licensing Program Analyst (LPA) Talwinder Bains and Licensing Program Manager (LPM) Laura Munoz arrived at the facility unannounced to deliver complaint findings and met with Administrator, Jacob Bostanchyan.


The department conducted records review ,facility observations, staff and residents interviews to investigate the complaint.



**Report continued on LIC9099-C**
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
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 2
Control Number 59-AS-20250113142420
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BETHESDA SENIOR CARE
FACILITY NUMBER: 342700545
VISIT DATE: 01/29/2025
NARRATIVE
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***Report continued from 9099....

Allegation- Facility is trying to evict resident illegally.

The Department conducted facility’s observations, reviewed records, interviews with one staff and one resident to investigate this allegation. Staff interview disclosed that facility was trying to vacate resident, R1 room as repair work (new floor, electric work and other repair) were needed in R1s room. The facility indicated the work would be completed in February 2025. Facility notified R1 and R1s family and placement agency in January 2025 regarding this matter and issued ‘Temporary Relocation’ notice for R1. Facility reached out to Department regarding to this matter prior to this complaint and rescinded this ‘Temporary Relocation’ notice per Department’s directions since it was not allowable under Title 22 Regulations. Record review and staff interview reflected that facility never issued an eviction notice to R1 regarding this issue. Interview with R1 indicated that they were happy with the care and services from staff and were aware that repair work was needed in their room and facility was not trying to evict them. During facility visit on 01/14/25, Department observed that repair work was needed in R1s room. Based on gathered information, this allegation was found to be UNFOUNDED.

Based on information obtained, LPA finds the allegation to be UNFOUNDED-means that the allegation is false, could not have happened, and/or is without a reasonable basis.


Exit interview conducted, and a copy of the report was provided.




SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2