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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 10/29/2020
Date Signed: 10/29/2020 04:43:08 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
03/20/2020 and conducted by Evaluator Aja Richardson
COMPLAINT CONTROL NUMBER: 31-AS-20200320160751
FACILITY NAME:GARDENS AT PARK BALBOA, THEFACILITY NUMBER:
197602434
ADMINISTRATOR:JOHN PURDUEFACILITY TYPE:
740
ADDRESS:7046 KESTER AVENUETELEPHONE:
(818) 787-0462
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:120CENSUS: 72DATE:
10/29/2020
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Julio ArriagoTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility not providing clean and sanitary environment
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 walls and floors are dirty, facility staff are not wearing gloves when serving food, and there is not enough handsanitizer. During the tour, LPA observed that the carpet and facility furniture, walls, and floors were clean and in good repair. LPA also observed hand sanitizers throughout building. Also, all of the residents interviewed were satisfied with the cleanliness of the facility yand believed the staff did an excelent job ensuring a sanitary environment.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja RichardsonTELEPHONE: (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)
Page: 1 of 3
Control Number 31-AS-20200320160751
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDENS AT PARK BALBOA, THE
FACILITY NUMBER: 197602434
VISIT DATE: 10/29/2020
NARRATIVE
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Residents also confirmed that staff wear gloves while serving food. .Based on the information above there is insufficient evidence that the facility is not providing a clean and sanitary environment. This allegation is Unsubstantiated at this time.

Exit Interview Conducted. Report Issued. Do to virtual visit LPA requested hard copy signed and returned.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja RichardsonTELEPHONE: (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
LIC9099 (FAS) - (06/04)
Page: 3 of 3