197602434-4-7-2023-29-AS-JAPL-CQZ2MG-20230417173108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 04/07/2023
Date Signed: 04/07/2023 03:43:41 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
05/31/2022 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20220531101335

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: 100	DATE:	04/07/2023
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Buisness Office Manager Katia Arriaga		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff stole residents personal belongings.
Staff stole residents medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit to deliver the findings on the above allegations. The LPA met with Buisness Office Manager Katia Arriaga and explained the reason for the visit.

On 6/1/2022, LPA Salia Walker, conducted an interview with the Administrator from 9:30 a.m. until 10:06 a.m. From 10:20 a.m. until 11:45 a.m., the LPA conducted interviews with facility residents. On 2/15/2023, LPA Campos spoke with Administrator Dion Gallarza, collected documents at 11:00 a.m., conducted interviews with facility staff at 11:35 a.m.,11:41 a.m. and 2:57 p.m. and conducted interview with resident at 3:09 p.m.

**Continued on LIC 9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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-20220531101335

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: 04/07/2023

NARRATIVE

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Regarding the allegation: Staff stole residents personal belongings.

It is being alleged that staff stole Resident’s personal belongings. To investigate, the LPA conducted interviews with residents and staff. Interviews revealed that the staff in question is no longer employed at the facility for unrelated reasons and was dismissed from their position about 3 years ago. Interviews with resident’s denied claims of any missing belongings. Initial complaint report with the name of the staff who allegedly took resident’s property, date when the incident possibly occurred were not consistent. Of the staff named, interviews with staff denied witnessing staff taking and/or stealing any resident belongings. Administrator Dion Gallarza informed and confirmed to the LPA that they do not have a staff by the name that was provided or that they have had any incidents of residents missing personal belongings. Residents further expressed positive experiences at this facility and denied otherwise observing or experiencing staff stealing personal belongings from residents.

Based on the information obtained, there is insufficient evidence to support the claim that facility staff stole residents’ personal belongings. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff stole residents medication

It is being alleged that staff stole Resident’s medication. To investigate, the LPA conducted interviews with residents and staff. Interviews revealed that the staff in question is no longer employed at the facility for unrelated reasons and was dismissed from their position about 3 years ago. Interviews with resident’s denied claims of any missing medications. Initial complaint report with the name of the staff who allegedly took resident’s medication, date when the incident possibly occurred were not consistent. Of the staff named, interviews with staff denied witnessing staff taking and/or stealing any resident medication. Administrator Dion Gallarza informed and confirmed to LPA that they do not have a staff by the name that was provided or that they have had any incidents of residents missing medication. Residents further expressed positive experiences at this facility and denied otherwise observing or experiencing staff stealing residents’ medication.

Based on the information obtained, there is insufficient evidence to support the claim that facility staff stole residents’ medication. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

LIC9099 (FAS) - (06/04)

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