197603652-3-19-2024-31-AS-TAGD-D7UU3J-20240805151337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603652
Report Date: 03/19/2024
Date Signed: 03/19/2024 02:26:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230919091551

FACILITY NAME:	AMBASSADOR GARDEN		FACILITY NUMBER:	197603652
ADMINISTRATOR:	SOFI DRUKER		FACILITY TYPE:	740
ADDRESS:	7324 CANBY AVENUE		TELEPHONE:	(818) 705-3404
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	158	CENSUS: 70	DATE:	03/19/2024
		UNANNOUNCED	TIME BEGAN:	08:43 AM
MET WITH:	Sofi Drucker - Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff yelled at resident while in care

Staff did not ensure that resident received assistance while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Administrator Sofi Drucker and explained the reason for the visit.

LPA conducted a physical plant tour at 9:12 AM, requested copies of facility documents relevant to the investigation at 9:42 AM, reviewed facility documents between 10:00 AM and 11:000 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that staff yelled at resident while in care, it was alleged that a staff yelled at Resident #1 (R1). LPA's interview with eight (8) residents or more than 10% of the current census on 09/22/23 between 10:50 AM to 11:45 AM and today between 11:00 AM to 1:00 PM revealed that eight (8) out of eight (8) residents did not experience being yelled at by any staff nor witnessed any resident being yelled at by any staff. LPA's interview with the administrator today at 11:35 AM also revealed that whenever she used the public address (PA) system for general address, she has to talk loud because some of the residents are hard of hearing. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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 31-AS-20230919091551

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: AMBASSADOR GARDEN	FACILITY NUMBER: 197603652
	VISIT DATE: 03/19/2024

NARRATIVE

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(continued from LIC 9099)

Further interviews with staff also revealed that R1 was also hard of hearing so people around R1 including staff tend to talk loudly and near R1.

Regarding the allegation that staff did not ensure that residents received assistance while in care, it was alleged that whenever R1 calls via intercom, staff do not respond. LPA's interview with eight (8) residents or more than 10% of the current census on 09/22/23 between 10:50 AM to 11:45 AM and today between 11:00 AM to 1:00 PM revealed that eight (8) out of eight (8) residents the staff provided all the care they need and staff are respectful and attentive. All eight (8) residents interviewed also stated that staff respond to their calls almost immediately or within ten (10) minutes.

Based on the information gathered during this and prior visits, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC9099 (FAS) - (06/04)

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