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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603977
Report Date: 04/04/2023
Date Signed: 04/04/2023 10:48:26 AM


Document Has Been Signed on 04/04/2023 10:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:EDEN GARDEN "C", INC.FACILITY NUMBER:
197603977
ADMINISTRATOR:YADIDI, ROHANGIZFACILITY TYPE:
740
ADDRESS:23601 CANZONET ST.TELEPHONE:
(818) 348-2308
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 6DATE:
04/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Rohangiz YadidiTIME COMPLETED:
10:55 AM
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On April 4, 2023, Licensing Program Analyst (LPA) KaSandra Lopez met with Administrator Rohangiz Yadidi for an unannounced Case Management visit to issue a civil penalty per Health and Safety Code §1569.49(f).

On July 5, 2019, the Department received a complaint alleging a resident (R1) sustained a fracture and developed several serious medical conditions while in care at the facility, and that the facility failed to meet R1’s needs. The Department initiated the complaint investigation on July 5, 2019.

On January 29, 2020, the allegations were substantiated and the licensee was cited for violating California Code of Regulations (CCR) Title 22, Section 87466 Observation of the Resident due to the licensee’s failure to ensure proper care and supervision was provided for R1, as R1 sustained a fall while in care, which resulted in a skull fracture. R1 also developed several serious medical conditions while in care; therefore, the licensee was also cited for 87405(d)(1) Administrator – Qualifications and Duties, due to the Administrator failing to demonstrate knowledge of the requirements for providing care and supervision to R1. An immediate civil penalty of $500 was also assessed for a violation of CCR Title 22, Section 87466 Observation of the Resident. The licensee was also informed that an additional civil penalty might be assessed based on Health and Safety Code §1569.49.

The investigation revealed that R1 was brought to a hospital emergency room on June 26, 2019 due to a noted change of condition, and upon admission, was diagnosed with severe sepsis, lactic acidosis, and a Urinary Tract Infection (UTI). The Emergency Department notes reflect R1 was diagnosed with ‘urosepsis,’ which is sepsis caused by infections of the urinary tract. R1’s condition was not improving after sepsis and UTI treatment; hence, a scan of R1’s head was done on July 2, 2019 to rule out any differential diagnoses. The scan revealed R1 sustained a skull fracture and intracranial hemorrhaging.

Report continued on LIC 809-C.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: EDEN GARDEN "C", INC.
FACILITY NUMBER: 197603977
VISIT DATE: 04/04/2023
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Staff who provided care to R1 claimed that on the morning of June 26, 2019, R1 was found on the floor. Staff indicated that R1 appeared unkempt, and staff were able to get R1 up from the floor and then showered R1. Staff said that the Administrator took R1 to the hospital thereafter. Information obtained from staff interviews did not reveal that staff informed the Administrator that R1 had suffered a fall. An interview was conducted with the Administrator on July 5, 2019, in which they initially stated that they were contacted by staff when they claimed that ‘something was wrong’ with R1. Whereas there were inconsistent statements of the facility staff regarding the time and/or date of fall, staff confirmed that R1 suffered a fall prior to R1 being sent to the hospital. The Administrator initially denied knowledge of R1 suffering a fall; yet, they conceded to the possibility that R1 had fallen, and that staff whom observed it did not reveal this to them. The Administrator confirmed that upon seeing R1 on June 26, 2019, R1 was unable to get up, and per the Administrator, R1 was cold and they were ‘shaking.’ According to Mayo Clinic, this behavior change is a symptom of a head injury.

The Department has concluded an analysis and has determined that a civil penalty is warranted for a violation that resulted in R1 sustaining serious bodily injury while under the care of this facility. The Welfare and Institutions Code § 15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the licensee’s failure to properly evaluate R1 and develop a sufficient understanding of R1’s needs to ensure R1 received proper care and supervision. Interviews conducted with facility staff and R1 revealed information consistent with R1 suffering a fall while in care at the facility, resulting in serious bodily injuries – skull fracture and intracranial hemorrhaging.

Today, April 4, 2023, the Department is issuing a civil penalty per Health and Safety Code §1569.49(f) in the amount of $10,000 for a violation that the Department constitutes as serious bodily injury. However, since an immediate civil penalty of $500 was previously issued on January 29, 2020, the amount of the civil penalty issued is reduced to $9,500. A copy of the LIC 421D was given to the Rohangiz Yadidi and originals were signed.

Exit interview conducted. A copy of the report issued. Appeal Rights provided. Rohangiz Yadidi signature on this report acknowledges receipt of the Appeal Rights, found on page two of LIC 421D.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
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