191801803-8-11-2023-28-AS-LHIS-CVPLB8-20230915083619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191801803
Report Date: 08/11/2023
Date Signed: 08/11/2023 01:07:52 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
08/04/2023 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230804120943

FACILITY NAME:	GARDEN CREST		FACILITY NUMBER:	191801803
ADMINISTRATOR:	CAROL ICE		FACILITY TYPE:	740
ADDRESS:	889 LUCILE AVE		TELEPHONE:	(323) 663-8281
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90026
CAPACITY:	44	CENSUS: 21	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Leo Del Rosario, Administrator		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Staff failed to safeguard resident's personal belongings.

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 DSP Estrella Joaquin. Administrator was explained the purpose of the visit telephonically.

The investigation consisted of: A tour of the interior and exterior physical plant was conducted, with focus on laundry area and R1's room. Staff (S1- S5) and residents (R1-R6) were interviewed. The following documents were reviewed and obtained: Face Sheet, Physician's Report (10/4/2017), Emergency Department Summary (6/26/23), Admission Agreement, incident report (6/26/23), Appraisal, staff roster, and resident roster. Note: A case management visit was created in reference to record review.

***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: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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-20230804120943

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: GARDEN CREST	FACILITY NUMBER: 191801803
	VISIT DATE: 08/11/2023

NARRATIVE

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Allegation: Staff failed to safeguard resident's personal belongings. It is alleged that staff (S1) is stealing resident (R1's) belongings i.e.,underwear and clothes. Based on interviews conducted the findings indicate that resident (R1) recently had a change in condition resulting in cognitive impairment due to a recent infarct that is causing confusion, aggression, and memory loss. Four (4) staff were interviewed, of which all denied the allegation. Staff (S1) stated that during the past three (3) months the resident has been getting more confused and verbally aggressive. Resident (R1) is accusing staff of stealing their clothes and changing their room TV channel. Last week, R1 became verbally and physically aggressive; grabbed staff (S1's) arm in the dining room demanding the resident's underwear be returned. Administrator stated that the resident's Power of Attorney was notified and the facility is looking into the accusations. Administrator stated that staff (S1) has no disciplinary action on record, is trusted, and a good employee.

A total of six (6) residents were interviewed. Two (2) out of the six residents reported that they have had clothing items missing i.e., shirts and underwear. Resident (R1) stated that staff (S1) stole underwear from the room drawer. Another resident stated that their clothes were sent to be washed by staff and at least 3 shirts were not returned. Four (4) residents stated staff (S1) is a good employee and trustworthy. LPA toured the laundry room area that is shared by the SNF next door and this facility. The area was observed to be well organized. No miscellaneous clothing items were observed laying around in the laundry room. Based on record review of R1's file, a change in condition was noted in the most recent doctor visit date 6/26/2023. Therefore, there is insufficient evidence to corroborate 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 Administrator Leo Del Rosario. 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: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

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