197603652-12-20-2022-31-AS-NMAN-CPVQFA-20230313120738

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603652
Report Date: 12/20/2022
Date Signed: 12/20/2022 12:52:40 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20221207140538

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: 72	DATE:	12/20/2022
		UNANNOUNCED	TIME BEGAN:	09:47 AM
MET WITH:	Sofi Druker		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility has mold/ mildew problem
Facility elevator is not operating
Resident has been confined to their room
Residents are locked in facility at night.

INVESTIGATION FINDINGS:

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At 9:50 a.m. on 12/20/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the Administrator and disclosed the reason for the visit. LPA toured the facility inside and out and observed no immediate health or safety concerns.

LPA interviewed 10% of residents and inspected rooms from 10:00 a.m. to 12:00 p.m. LPA interviewed the Administrator and staff from 12:00 p.m. to 12:40 p.m.

Regarding the allegation “Facility has a mold/mildew problem”, it was alleged resident rooms contain mold and mildew. From interviews, most residents and staff had no issues with mold or mildew in the facility. From room inspections, LPA noticed some minor signs of wear and tear but no immediate or potential risks to health or safety. Based on interviews and inspections, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

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 31-AS-20221207140538

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMBASSADOR GARDEN	FACILITY NUMBER: 197603652
	VISIT DATE: 12/20/2022

NARRATIVE

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Regarding the allegation “Facility elevator is not operating”, it was alleged the facility elevator was not working for an extended period of time. The allegation was previously investigated on 11/30/2022 as part of complaint investigation #31-AS-20221129091305. At 2:38 p.m. on 11/30/2022 LPA reviewed records related to elevator repairs and facility efforts to alleviate the situation. From interviews today, most residents noted the elevator has been out of order for several months, but they have not had issues using the stairwells to access the first floor. The Administrator has offered all residents room changes to the first floor, and staff have accommodated resident needs in the meantime. Staff have transported walkers, groceries, and personal belongings up and down the stairs, and meals and medications have been offered to upstairs residents. Based on interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Resident has been confined to their room”, it was alleged Resident #1 (R1) has been confined to their room due to their inability to use the stairs and elevator. From interviews, R1 noted they can get down the stairs in an emergency. R1 preferred not to be carried or transported by other means. R1 and the Administrator noted a room change was offered, but the room was not to the liking of R1. R1 further stated that they want to keep their second floor room but want the elevator to work soon. Facility offerings for tray service and medication have met R1’s needs. Based on interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Residents are locked in facility at night”, it was alleged residents are unable to leave the facility at night after the doors are locked. From interviews, R1 stated there is only one overnight staff with the key for the front door. The Administrator stated the doors remain unlocked from the inside but locked from the outside. The facility locks the doors every night at 9:00 p.m. for resident safety. Based on interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided. Appeal rights discussed.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

LIC9099 (FAS) - (06/04)

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