Complaint Investigation Report

197610595-4-9-2025-31-AS-NMAN-DHXUNX-20250624154439

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

12/19/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20241219103942

Licensing Program Analyst (LPA) Abeye Duguma conducted a subsequent complaint visit for the above allegation.

At approximately 10:00 AM, LPA met with caregiver, Yelena Grigoryan, explained the reason for the visit and was granted access to the home to conduct an inspection. During the inspection, LPA observed four (04) residents in the facility and one (01) staff. Resident #1 (R1) that required a higher level of care and supervision is no longer in the home.

At around 10:15 AM, LPA conducted a physical plant tour to ensure health and safety.

Although the operator relocated R1, the allegation will remain SUBSTANTIATED at this time.

A NOTICE OF OPERATION IN VIOLATION OF LAW was served on 12/19/2024 prior to licensure.

No additional citations issued at the time. Exit interview conducted and report issued.