197602434-7-1-2025-29-AS-KHEN-DJZVS5-20250728164058

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 07/01/2025
Date Signed: 07/01/2025 04:34:38 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
06/24/2025 and conducted by Evaluator Christine Yee

COMPLAINT CONTROL NUMBER: 29-AS-20250624113912

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:	DATE:	07/01/2025
		UNANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Dion Gallarza, Executive Director		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1. Staff did not provide proper mobility assistance to residents in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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

On today's visit LPA Yee conducted an interview with the Executive Director at 11:04am, Staff #1 at 11:37am, Staff #2 at 12:04pm, Staff # 3 at 12:55pm and Resident #2 at 1:42pm. LPA attempted to interview Resident #1 but resident refused. Facility records were reviewed and copies obtained.

Per information obtained during the investigation, regarding the above allegation that staff did not provide proper mobility assistance to residents in care, it was revealed that Staff #2, Staff #4 and Staff #5 were in the breakroom taking their break on 6/8/25. When Staff #2 left the breakroom, Staff #4 made an unkind comment about the way Staff #2 dresses to Staff #5. Staff #5 went and told Staff #2 about the comment

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025

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 29-AS-20250624113912

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: 07/01/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

made by Staff #4. The comment made by Staff #4 upset Staff #2. Staff #2 approached Staff #1, Maintenance Director, and informed them about the comment made by Staff #4. Staff #2 was told by Staff #1 that they would investigate the incident. On the same day, the Maintenance Director had all three staff submit written statements regarding what happened in the breakroom. Staff #5 was counseled on 6/11/25 and Staff #4 was counseled on 6/12/25. Staff #4 and Staff #5 were also required to take online training in Harassment in the Workplace and Violence in the Workplace.

Per interviews conducted with the Executive Director and Staff #1, Staff #4 has worked at the facility for about 4 months and they have received staff complaints about Staff #4. Staff #4, who works as a housekeeper, likes to tell staff what they should be doing and what they are doing wrong. Staff #4, likes to boss other staff around and was told by their supervisor that they are to address their concerns with a supervisor, not with the staff. Staff #4 also rubs the other staff the wrong way. The Executive Director, Staff #1 and Staff #3 also indicate that Staff #2 is a very good caregiver. Staff #2 is always happy, has a good attitude, very attentive towards the residents, has a great attitude, friendly, very helpful and enjoys working with the residents. Staff #2 has not received any complaints or write ups. As a result of the breakroom incident and staff being counseled, they believe that Staff #2 is being targeted.

Per interview conducted with Staff #2, staff denies ever refusing to assist a resident or leaving any resident with their legs hanging off the bed unless they requested it that way. Staff #2 will also asks residents if they want to go back to their room. Per Staff #2, they love all the residents. Per Staff #2, they may not be able to immediately assist a resident because they are assisting someone else at the time but another staff will cover them. Per Interview conducted with Resident #2, they confirm that Staff #2 is sweet and loves to help the resident. Per Resident #2, Staff #2 likes to sing, dance and is happy. Staff #2 has not refused to assist them. Staff #2 bends over backwards to help the residents. Per Resident #2, they have great caregivers here.

Based on the information received during today's investigation, there is insufficient evidence to support the allegation that Staff did not provide proper mobility assistance to residents in care, therefore the allegation is unsubstantiated at this time.

Exit interview was conducted.

SUPERVISOR'S NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2