197603746-3-22-2023-31-AS-RRAZ-CQYP9K-20230417110715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603746
Report Date: 03/22/2023
Date Signed: 03/22/2023 01:44:35 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
10/10/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20221010155026

FACILITY NAME:	ROYAL GARDEN BOARD AND CARE II		FACILITY NUMBER:	197603746
ADMINISTRATOR:	RADA KIGEL		FACILITY TYPE:	740
ADDRESS:	5909 MELVIN AVENUE		TELEPHONE:	(818) 609-7753
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	6	CENSUS: 3	DATE:	03/22/2023
		UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Sophia Labendze		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Questionable death
Staff did not seek medical attention to resident in a timely manner.
Staff did not check on resident in care.

INVESTIGATION FINDINGS:

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Questionable death
Staff did not seek medical attention to resident in a timely manner.
Staff did not check on resident in care.

Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted a subsequent visit to the facility to conclude the investigation regarding the above allegations. On 10/10/22, it was reported that Resident 1 (R1) was found lying in bed covered from head to toe in an excess of feces. It was further alleged that R1’s death could have been avoided with proper care and monitoring by facility staff. The investigation consisted of interviews with the licensee, administrator, staff and R1’s family. The LPA also obtained copies of R1’s facility records, death certificate and paramedic report.

On 10/11/22, LPA Cava conducted the 10 day visit to the facility to initiate the investigation. LPA met with the licensee, Sophia Labendze, and the administrator, Rada Kigel, and advised them of the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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-20221010155026

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: ROYAL GARDEN BOARD AND CARE II	FACILITY NUMBER: 197603746
	VISIT DATE: 03/22/2023

NARRATIVE

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complaint. Interviews with both the licensee and the administrator deny the allegation of neglect, resulting in R1’s death. They both state on the night, prior to R1’s death, R1 was checked on constantly to insure no incontinence or bowel movement. A review of R1’s appraisal does indicate assistance with toileting needs. LPA also conducted interviews with facility staff, who denied the allegation of neglect, resulting in R1’s death. Staff confirmed routine check was made at approximately 6am when R1 was still responsive.

According to the licensee and administrator, law enforcements were called when the paramedics arrived. Law enforcement, along with their supervisor, made their investigation, and ruled the death “Natural”.

On 10/27/22, LPA spoke with R1’s family, who didn’t feel R1’s death was a result of facility neglect. R1’s family confirmed that there was awake staff that would check on R1 every two hours. R1’s family would visit R1 often and they would never observe R1 soiled in their diaper during their visits. R1’s family was satisfied with care and supervision provided and expressed no complaints.

On 10/28/22, LPA received a copy of R1’s Death Certificate. Immediate cause of death is Cardiopulmonary Arrest.

On 01/10/23, paramedic report was received. Per LPA review, there was no additional information on the report that had already been provided pertaining to R1’s condition at attendance. Although there was mention of neglect on the report, there were no witnesses or confirming evidence to indicate that R1’s death was a result of neglect.

Based on the information obtained, there is insufficient evidence to prove that R1’s death was a result of staff not seeking medical attention in a timely manner, or staff not checking on resident in care. Therefore, the allegations are deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC9099 (FAS) - (06/04)

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