197602434-7-7-2022-29-AS-JAPL-CHD26F-20220816170705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 07/07/2022
Date Signed: 07/07/2022 03:53:52 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, 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
12/17/2021 and conducted by Evaluator Salia Walker

COMPLAINT CONTROL NUMBER: 29-AS-20211217112145

FACILITY NAME:	GARDENS AT PARK BALBOA, THE		FACILITY NUMBER:	197602434
ADMINISTRATOR:	DION D GALLARZA		FACILITY TYPE:	740
ADDRESS:	7046 KESTER AVENUE		TELEPHONE:	(818) 787-0462
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	120	CENSUS: 82	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Dion Gallarza, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Dining hall heater is in disrepair

Transportation is not available to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint visit. The purpose of the visit is to deliver the findings for the above allegations. Upon entry, the LPA met with Administrator Dion Gallarza, and explained the reason for the visit.

On 12/21/2021, LPA Walker conducted an initial complaint inspection for the above allegations. During the visit, the LPA conducted a physical plant tour with the Business Office Manager, Katia Arriaga, at 11:36 a.m. From 12:16 p.m. until 12:43 p.m.; and between 3:08 p.m. until 4:12 p.m., the LPA conducted interviews with three (3) staff. From 12:54 p.m. until 1:40 p.m., the LPA conducted an interview with the administrator. From 2:20 p.m. until 3:08 p.m., the LPA reviewed and obtained copies of documents pertinent to the investigation. From 4:30 p.m. until 4:49 p.m., the LPA conducted interviews with two (2) facility residents. The LPA determined further investigation was needed at that time.
Contine on LIC9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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 29-AS-20211217112145

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: 07/07/2022

NARRATIVE

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On 06/01/2022, LPA Walker conducted a subsequent complaint inspection for the above allegations. During the visit, the LPA conducted interviews with facility residents from 10:20 a.m. until 11:45 a.m. From 12:28 p.m. until 12:40 p.m., the LPA conducted an interview with the Administrator. The LPA determined further investigation was required prior to issuing findings.

Regarding the allegation, ‘Dining hall heater is in disrepair,’ the complainant’s concern is that the facility heater in the dining room was in disrepair for 3 weeks. According to the complainant space heaters were provided by the facility. However, the complainant is concerned that the space heaters were placed in an area hazardous to resident.

On 12/21/21, LPA Walker conducted a physical plant tour and observed temporary space heaters in the facility dining room. The LPA noted that the facility placed ‘warning signs’ next to all space heaters, and ensured the location of the space heaters were not a hazard to facility residents.

During the investigation, LPA Walker conducted a record review, interviews with the Administrator, facility staff, and residents. Record review revealed that the facility had the dining room heater fixed in a timely manner. Interview with the Administrator revealed that the facility provided temporary space heaters to accommodate facility residents until the dining room heater was fixed. Interview with the Administrator also revealed that the company contacted initially came to the facility and fixed the heater. According to the Administrator, after the initial fixture of the dining room heater ‘it broke down again.’ The Administrator stated that the company was contacted once more, and they repaired the dining room heater. However, ‘had to order a new part,’ and it ‘took a while to arrive.’ Interviews with facility staff revealed that the Administrator contacted ‘the company to have the heater fixed,’ and due to the heater needing a part ordered the repairs delayed. Interviews with facility residents revealed that the Administrator informed the residents of the attempts to repair the dining hall heater, and ‘put space heaters’ meanwhile. Interviews with facility residents also revealed that the heater ‘was fixed, but went out again a few days later.’

Based on LPAs observation, record review, and interviews which were conducted. There is insufficient evidence to support the allegation ‘Dining hall heater is in disrepair.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Continue on LIC9099C..

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20211217112145

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: 07/07/2022

NARRATIVE

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Regarding the allegation, ‘Transportation is not available to residents,’ the complainant’s concern is that the facility bus service was down for a month, and that there is no driver now that the bus is fixed.

During the investigation, LPA Walker conducted a record review, interviews with the Administrator, facility staff, and residents. Record review revealed that the facility transportation vehicle is a ‘2006’ year model. Record review also revealed that the facility has had multiple repairs done to the transportation vehicle varying from maintenance, to body parts. Interview with the Administrator revealed that the ‘facility van was in the shop’ for a couple of weeks, and that is has been in disrepair on and off due to it being and older vehicle. Interview with the Administrator also revealed that there was a short period when the facility did not have a driver. However, the Administrator stated that additional staff who were crossed trained assisted in transporting residents to appointments, while the facility hired a new driver. Additionally, the Administrator advised the LPA that the facility provided all residents with alternative transportation services through the means of ride share companies paid by the facility.

Interviews with facility staff revealed that the facility ‘bus’ was not operating for approximately a month. Interviews with facility staff also revealed that residents were provided ‘other options of transportation,’ such as ‘Uber, Lyft, and Access’ which was either paid by the facility; or ‘reimbursed to the residents if the ride was placed on their account.’ Interviews with facility residents revealed that the Administrator notified the residents of the ‘bus’ being out of service. Interviews with facility residents also revealed that the facility provided ‘Access, Uber or Lyft’ transportation ‘free of charge.’ Interviews with facility residents revealed that ‘the bus had on going issues, but the staff announced every time if it needed fixing,’ and the ‘facility reimbursed [the residents] for the times they used Uber, Lyft, or Access.’

Based on record review, and interviews which were conducted. There is insufficient evidence to support the allegation ‘Transportation is not available to residents.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted, and a copy of the report was emailed.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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