197602434-10-30-2024-29-AS-KHEN-DBD2T3-20241125164005

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 10/30/2024
Date Signed: 10/30/2024 07:18:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
10/24/2024 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20241024130944

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: 104	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Dion D. Gallarza, Executive Director		TIME COMPLETED:	01:53 PM

ALLEGATION(S):

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1. Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Dion Gallarza, Executive Director. The reason for today's visit was explained.

On today's visit, LPA Yee conducted an interview with the Executive Director at 10:44am, Resident #2 at 11:18am and Resident #3 at 12:29pm. Prior to today's visit, LPA Yee interviewed Resident #1 via telephone on 10/28/24 at 1:30pm.

The Department received a complaint on 10/24/24 alleging that Staff did not safeguard residents' personal belongings. Per interviews conducted, Resdient #2 took Resident #1's black gel pillow that was left in the dining room. Per interviews conducted, upon inquiry of the residents present in the dining room, Resident #3 advised Resident #1 that Resident #2 was seen with the missing pillow next to them. Resident #2 was

Continued on LIC9099-c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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-20241024130944

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: GARDENS AT PARK BALBOA, THE	FACILITY NUMBER: 197602434
	VISIT DATE: 10/30/2024

NARRATIVE

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asked by Resident #1 about the pillow and Resident #2 admitted seeing the pillow.
Per Resident #2, who has mild cognitive impairment and has memory lapses, they admitted seeing the pillow and must have picked up the pillow because they believed it was theirs. Per Resident #2, stealing is not in their character, Resident #2 told Resident #1 that the pillow was in their room. When they went to Resident #2's room, the pillow was not in the room. Resident #2 stated that maybe they left their room door unlocked and someone came in and took it. Per Resident #1, the Executive Director was told about the missing pillow and they were advised that he would look into it. Resident #1 did not hear back from the Executive Director and so Resident #1 contacted the Department to see if someone would speak with Resident #2 so they would return their pillow. Per Resident #1, they did not say that staff did not safeguard their pillow.

Per interview with the Executive Director, Resident #1 approached him on 10/25/24 regarding the lost pillow. Per the Executive Director, they searched Resident #2's room and the pillow was no where to be found. Resident #2 has no idea what happened to the pillow due to the memory lapses. Per the Executive Director, he is constantly reminding the residents not to leave their personal belongings in the dining room or in the common areas. Staff aren't able to keep an eye on their belongings all the time and they need to remember to pick up their personal belongings. Per the Administrator, they will continue to look for the lost pillow.

Based on the information received on today's visit, there is insufficient evidence to support the allegation that the staff did not safeguard the resident's personal belongings, therefore the allegation is unsubstantiated at this time.

Exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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