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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880912
Report Date: 05/01/2023
Date Signed: 05/01/2023 12:54:15 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2023 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230427101245
FACILITY NAME:A & A CARE AND WELLNESSFACILITY NUMBER:
361880912
ADMINISTRATOR:AKOPYAN, HELENFACILITY TYPE:
740
ADDRESS:16055 SEQUOIA STREETTELEPHONE:
(818) 588-2894
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:6CENSUS: 3DATE:
05/01/2023
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Helen Akopyan, LicenseeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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The facility does not have enough staff to care for the residents needs.
The staff is working without a background clearance.
Facility staff are not qualified.
The facility is not providing meals of nutritional value.
The facility does not have the required amount of food based on regulation.
The residents mediations are not secure
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to deliver the finding on the above allegations. LPA Nickolas met with Licensee Helen Akopyan and explained the purpose of the visit. The investigation included a facility tour, file reviews, and in interview with relevant party.

Allegation #1 “The facility does not have enough staff to care for the resident’s needs”. The facility does not have enough staff to care for the resident’s needs”. The allegation alleged that the facility does not have enough staff. The allegation alleged that the facility is a level IV (4) facility and should have at least two (2) staff members per shift but never two (2) staff are available per shift. LPA Nickolas' interview with the Licensee revealed that the facility currently has four (4) employees on staff and three (3) clients in care. The Licensee stated that there is one (1) staff per shift. LPA Nickolas' file review confirmed the facility's number of employees and clients. LPA Nickolas' file review of the California Code of Regulations (CCR) revealed that the facility had not violated regulations and had enough employees working there. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023
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 56-AS-20230427101245
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: A & A CARE AND WELLNESS
FACILITY NUMBER: 361880912
VISIT DATE: 05/01/2023
NARRATIVE
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Allegation # 2 “The staff is working without a background clearance”. The Reporting Party (RP) alleged that they did not apply nor a background check when hired. LPA Nickolas’ interview with the Licensee revealed that the former employee was provided an application; however, it was never returned to the Licensee. The Licensee stated that the former employee did have a criminal records clearance with the California Department of Social Services (CDSS) and was associated with the facility in the CDSS guardian background check system. LPA Nickolas’ file review revealed that the former employee had a criminal record clearance with CDSS and was associated to this facility in the CDSS guardian background check system. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #3 “Facility staff are not qualified. The allegation alleged the Licensee is not checking anyone’s qualifications before hiring them. LPA Nickolas’ interview with the Licensee revealed that the Licensee has potential employees complete an application. The Licensee stated that an interview with the potential employee is conducted after the application is completed. The Licensee stated that the potential employee would complete a criminal records clearance with CDSS. The Licensee stated that all employees are trained continuously, and the Licensee provided the training records to LPA Nickolas. LPA Nickolas’ facility file review of the training records revealed that all employees had received 40 hours of on-site orientation in 13 various training topics. The employees have signed and dated acknowledging completion of training. LPA Nickolas facility file review revealed that employees have also received various certifications for training. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #4 “The facility is not providing meals of nutritional value”. The allegation alleged that there are no meal plans and that only frozen foods and bread are purchased. The allegation alleged that none of the clients in the home get vegetables, fruits, or home-cooked meals. LPA Nickolas' interview with the Licensee revealed that the facility does have a menu. However, facility staff does not use the food menu to prepare meals. The Licensee stated that facility staff prepares meals for the clients based on what the clients prefer to eat. The Licensee stated that the facility staff always provides the clients with healthy options and integrates salads and low-carbohydrate options. LPA Nickolas' facility food audit revealed that the facility has plenty of fresh, frozen, and canned fruits and vegetables. LPA Nickolas' observed that the facility is offering clients a variety of foods to meet the client's nutrition needs. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 56-AS-20230427101245
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: A & A CARE AND WELLNESS
FACILITY NUMBER: 361880912
VISIT DATE: 05/01/2023
NARRATIVE
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Allegation #5: “The facility does not have the required amount of food based on regulation”. The allegation alleged that the facility’s refrigerator is empty, and no one cooks for the clients. LPA Nickolas' facility food audit revealed the facility had more than a seven (7) day supply of non-perishable foods and a two (2) day supply of perishable food. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #6 “The residents’ mediations are not secure. LPA Nickolas’ interview with the Licensee revealed that the medications are locked in a locked cabinet. During LPA Nickolas’ facility tour, the Licensee showed LPA Nickolas where the medications were stored. LPA Nickolas’ observed the Licensee unlock the secured filing cabinet where the medications were stored. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of Unsubstantiated means 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.

An exit interview was conducted and copy of this report was provided.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4