197602434-3-27-2023-29-AS-JAPL-CQDUEC-20230329153056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 03/27/2023
Date Signed: 03/27/2023 03:26:16 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
01/24/2023 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20230124155934

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: 98	DATE:	03/27/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Dion Gallarza		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff do not ensure a safe and healthful environment by accord dignity in their relationship with a resident
Staff yelled at a resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to deliver findings to the above facility. LPA Ascencio met with Executive Director (ED) Dion Gallarza at 10:40 a.m. Entrance interview conducted.

On 01/23/2023, the Department received a complaint alleging that staff do not ensure a safe and healthful environment by according to dignity in their relationship with a resident and staff yelled at a resident. On 01/27/2023, LPA Ascencio met with Executive Director (ED) Dion Gallarza at 12:32 p.m. Interview with ED Gallarza revealed that Resident #1 (R1) has been wanting a room upgrade for some time, but the rooms R1 would like to move into were unavailable. Eventually a room became available, and our Marketing Director (MD) gave R1 a tour of the room.

Continued on LIC 9099 - C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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 29-AS-20230124155934

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: 03/27/2023

NARRATIVE

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MD called asking me to join them. ED Gallarza added that R1 has a history of accusation towards the staff, because of this, two (2) staff are always present when speaking with R1. When ED Gallarza arrived, R1 was visibly upset and yelling at MD. ED Gallarza added that R1 wanted to paint their new room a different color than what the facility provides. ED Gallarza gave R1 the choice to buy their own paint and would be happy to paint the room in that color, free of charge. R1 left the room yelling and cursing at MD and ED Gallarza.

That same day, interview with MD, at 1:40 p.m. confirmed what ED Gallarza stated. MD added that R1 was yelling and cursing at ED Gallarza and MD, both of which acted professional as they attempted to explain the situation to R1. MD stated they have been professional towards every resident, staff and visitor and has not witness anyone yell at residents.

Interview with R1 on 03/27/2023, starting at 12:43 p.m. confirmed what ED Gallarza and MD stated, but , R1 added that ED Gallarza and MD yelled, intimidated and threatened R1. R1 added that they are unhappy living here and would prefer to move to another place. R1 added that they eventually moved into the new room, but despite not having the room painted the way they wanted, it is nice to have a bigger room with an outdoor area. Staff interviews on 03/27/2023, starting at 12:30 p.m., revealed that staff are helpful and due their diligence to provide the best care possible for resident. Additionally, they have not heard of any staff yelling at residents. Lastly, staff stated they are always respectful and professional at all times when helping residents. That same day, resident interviews, starting at 12:37 p.m. revealed that the staff are very nice, helpful, and professional. Additionally, staff have not yelled, or been disrespectful in any way toward any resident. Lastly, resident interviews added that they feel safe and comfortable living at this facility.

Although R1 stated that ED Gallarza and MD yelled and threatened R1, interviews with ED Gallarza and MD stated differently by being respectful and professional towards R1. Additionally, staff and resident interviews supported claims that resident felt safe and supported while residing in this community and that staff and management are always professional when dealing with residents. Based on evidence gathered throughout the investigation, there is insufficient evidence to support the claims that staff do not ensure a safe and healthful environment by according to dignity in their relationship with a resident and staff yelled at a resident. Thus, the allegations are deemed Unsubstantiated at this time.Although there was insufficient evidence, LPA Ascencio spoke with ED Gallarza regarding resident rights and code of conduct for staff and residents. ED Gallarza stated they will have staff training on resident rights, as well as having the Long Term Care Ombudsman (LTCO) conduct a presentation with staff and resident regarding resident rights and code of conduct. Exit interview conducted and a copy of the report was issued to ED Gallarza.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC9099 (FAS) - (06/04)

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