197602434-10-29-2020-31-AS-JAPL-BUVQQ3-20201030122139

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 10/29/2020
Date Signed: 10/29/2020 01:30:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2020 and conducted by Evaluator Aja Richardson

COMPLAINT CONTROL NUMBER: 31-AS-20200311125454

FACILITY NAME:	GARDENS AT PARK BALBOA, THE		FACILITY NUMBER:	197602434
ADMINISTRATOR:	JOHN PURDUE		FACILITY TYPE:	740
ADDRESS:	7046 KESTER AVENUE		TELEPHONE:	(818) 787-0462
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	120	CENSUS: 7	DATE:	10/29/2020
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Julio Arriaga, Staff		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility is not clean

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Aja Richardson conducted a subsequent complaint visit for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted with staff Julio Arriago at 12:00 PM. The Adminstrator Dion Gallarza was interviewed at 10 am and was unavailable during the visit.

To investigate the above allegation, LPA conducted interviews with a random selection of residents on 10/21/2020 between 5-7pm and 10/28/2020 between 5-7pm. In addition on 10/29/2020, LPA Richardson conducted a facility tour at 12 pm. There are concerns that the faciity carpet and furniture are dirty and stained with urine. During the tour, LPA observed that the carpet and facility furniture was clean and in good repair. Also, all of the residents interviewed were satisfied with the cleanliness of the facility and there were no concerns of furniture having urine stains or carpet being dirty. Based on the information above there is insufficient evidence that the facility is not clean. This is allegation is Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020

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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