197608200-9-15-2021-31-AS-NMAN-C76PMS-20210924112650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608200
Report Date: 09/14/2021
Date Signed: 09/15/2021 10:06:54 AM

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
11/12/2020 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20201112132618

FACILITY NAME:	ALTA VISTA GARDENS		FACILITY NUMBER:	197608200
ADMINISTRATOR:	STACI MARMERSHTEYN		FACILITY TYPE:	740
ADDRESS:	829 NORTH ALTA VISTA BLVD.		TELEPHONE:	(323) 937-1940
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	70	CENSUS: 70	DATE:	09/14/2021
		UNANNOUNCED	TIME BEGAN:	08:51 AM
MET WITH:	Staci Marmeshteyn - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not meet resident's hygiene needs

Resident had lost a lot of weight due to neglect

Staff leaves resident in soaking wet clothing for extended period of time

Staff failed to seek medical attention for resident in a timely manner.

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 Staci Marmeshteyn and explained the reason for the visit.

LPA conducted physical plant tour at 9:15 AM. LPA requested and reviewed facility documents relevant to the investigation from 9:45 AM to 11:30 AM. LPA conducted interview with staff, residents and administrator between 11:30 AM to 1:30 PM. Regarding the allegation that Staff do not meet resident's hygiene needs, LPA's record review between 9:45 AM and 11:30 AM, revealed that Resident #1 (R1) almost always refused to take showers and assistance to clean self. LPA's interview with Resident #2 (R2) also revealed that staff always attend to R1's need but R1 refused and wanted to sleep naked.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

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-20201112132618

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: ALTA VISTA GARDENS	FACILITY NUMBER: 197608200
	VISIT DATE: 09/14/2021

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Resident had lost a lot of weight due to neglect, LPA record review revealed that R1 had a terminal illness and continuously declining and unable to eat properly due to the illness. LPA's interview with the administrator and staff at 12:20 PM also revealed that R1's food are pureed due to R1's illness but sometimes refused the facility food. The facility however, was able to obtain for R1 to have a liquid supplement (Ensure) that R1 took regularly.

Regarding the allegation that Staff leaves resident in soaking wet clothing for extended period of time, LPA's interview with R2 revealed that R1's diaper was being changed regularly by the staff. LPA's interview with the care staff however, revealed that R1 always removed and sometime refused to wear R1's pull up diaper as R1 would like to be naked all day.

Regarding the allegation that Staff failed to seek medical attention for resident in a timely manner, LPA record review revealed that R1's case manager was the one arranging for medical transportation for R1 to continue medical treatment but R1 refused to go multiple times. Further record review also revealed that the facility agreed to plan and arrange R1's medical and dental transportation and record shows that the facility did, but whenever R1 was about to be taken to the medical appointment, R1 refused. Moreover, dental appointment was not recommended by R1's doctor to be done as it might not able to heal due to R1's medical condition and additionally, LPA's interview with the administrator also revealed that R1 refused to have the dental procedure be done to R1.

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

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

LIC9099 (FAS) - (06/04)

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