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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 04/15/2021
Date Signed: 04/15/2021 03:47:29 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: 69DATE:
04/15/2021
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dion Gallarza, AdministratorTIME COMPLETED:
12:41 PM
ALLEGATION(S):
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Staff not maintaining residents hygiene
INVESTIGATION FINDINGS:
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Licensing Program Analyst conducted a subsequent complaint visit and met with the Administrator Dion Gallarza at 9:45 am and explained the reason for the visit.

Allegation: Staff not maintaining residents hygiene. There are concerns that residents look unkempt and dirty. To investigate the above allegation, LPA conducted a visits on 3/24/20 and met the Administrator John Perdue at 11:30 am, on 10/29/20, additonial interviews were conducted with Administrator Dion Gallarza at 12 pm and a random selection of residents. On today's visit at 12:45 pm, LPA conducted a faciltiy tour at 11:20 am and interviewed staff at 11:00 with staff and at 11:26 with additional residents. According to interviews conducted residents are satifisfied with the shower schedule and the staff do a good job maintaining schedule and assisting them with grooming.

Continued on 9099C..
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: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
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 2
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: 04/15/2021
NARRATIVE
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 During the tour LPA Richardson observed residents appearing to be well groomed and clean. At this time there is insufficient evidence to say staff are not maintaining resident's hygiene. This allegation is unsubstantiated at this time.

Exit interview conducted. Report emailed to Administrator.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja RichardsonTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2