197602434-7-7-2022-29-AS-JAPL-CH7T7F-20220811142840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602434
Report Date: 07/07/2022
Date Signed: 07/07/2022 03:52:28 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
06/29/2022 and conducted by Evaluator Salia Walker

COMPLAINT CONTROL NUMBER: 29-AS-20220629161030

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: 82	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Dion Gallarza, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Faucets used by residents for personal care such as shaving and grooming do not deliver hot water

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for an initial complaint inspection for the above allegation. The LPA met with Administrator Dion Gallarza at 8:25 a.m., and explained the reason for the visit.

During today’s visit, the LPA conducted a physical plant tour with Dion Gallarza, Administrator at 11:00 a.m. From 8:40 a.m. until 9:00 a.m., the LPA conducted an interview with the administrator; and obtained copies of documents pertinent to the investigation. From 9:15 a.m. until 11:00 a.m., the LPA conducted interviews with facility residents.

Continue on LIC9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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-20220629161030

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: 07/07/2022

NARRATIVE

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Regarding the allegation, ‘Faucets used by residents for personal care such as shaving and grooming do not deliver hot water,’ the complainant’s concern is that the facility had no hot water for 10 days. The complainant is also concerned that the facility is not following Title 22 Regulation section 87303(e)(2), and maintaining the hot water temperature between 105 and 120 degrees Fahrenheit. According to the complainant, the facility’s hot water temperature is usually ‘130 degrees F.’

To conduct the investigation, the LPA conducted a physical plan tour from 11:00 a.m. until 12:00 p.m. During the physical plant tour, a random selection of ten (10) resident rooms were inspected, and water temperatures were measured. Ten (10) out of ten (10) resident rooms hot water temperatures measure between 110.2 and 118.7 degrees Fahrenheit.

During the investigation, LPA Walker conducted a record review, interviews with the Administrator, and facility residents. Record review revealed that the facility had one (1) water heater removed which was damaged, and replaced on 06/29/22. Interview with the administrator revealed that on or about 06/21/22, residents notified the front desk that they had no hot water. Interview with the Administrator also revealed that the facility had four (4) different plumbing companies attempt to fix one (1) out of four (4) boilers, when a leak was discovered in the facility boiler room. According to the Administrator, from 06/22/22 through 06/29/22, the facility provided residents with updating Letters notifying residents of disrepair, and offered the residents alternative rooms with hot water while repairs were being made; as well as notification on 06/29/22, that ‘the Boiler was replaced, and the hot water should be up and running.’ Interviews with facility residents revealed that the facility hot water was working on half of the building, and that staff offered the residents the next day vacant rooms to shower. Interviews with facility residents also revealed that staff ‘assisted in helping the residents that did not have hot water by bringing the shower chairs and all supplies’ to the vacant room.

Although, one (1) out of four (4) facility’s hot water boilers were in disrepairs causing no hot water to be delivered on half of the building. The facility took immediate action, had the boiler replaced, notified facility residents, and provided alternative means by offering the residents vacant rooms on the half of the building which was delivering hot water until the boiler/water heater was replaced.

Continue on LIC9099C..

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220629161030

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: 07/07/2022

NARRATIVE

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Additionally, the facility is following Title 22 Regulation section 87303(e)(2), as faucets used by residents for personal care such as shaving and grooming hot water temperature measured not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).

Based on LPAs observation, record review, and interviews which were conducted. There is insufficient evidence to support the allegation ‘Faucets used by residents for personal care such as shaving and grooming do not deliver hot water.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted, and a copy of the report was emailed.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia Walker	TELEPHONE: 818-326-5838
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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