Complaint Investigation Report

197608550-10-17-2022-29-AS-DPEA-CKKPTG-20221026113556

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD. #250

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

10/14/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20221014141629

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint investigation for the allegation listed above. Upon arrival LPA met with Administrator Gohar Ambartsumyan and explained the reason for the visit. At approximately 9:30am, LPA conducted physical plant, interviewed staff and residents as well as reviewed and obtained copies of pertinent documents relevant to the investigation.

It was alleged that facility staff are not wearing PPE. Regional office received information from a credible witness that while visiting the facility, they observed that staff were not wearing masks. Upon arrival to the facility, LPA observed all staff wearing masks. However, LPA interview with the licensee, Administrator and Staff 1 (S1) revealed they recently had a visit from an outside agency who observed S1 and other staff not wearing a mask while working with the residents. Based on information gathered during the visit, the allegation of "Staff are not wearing PPE" is deemed SUBSTANTIATED at this time.

Citations Issued. See LIC 9099D. Appeal Rights discussed. Exit interview conducted and copy of the report issued and emailed to Administrator.