197608200-10-7-2022-31-AS-RRAZ-CK9TWN-20221016150546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608200
Report Date: 10/07/2022
Date Signed: 10/07/2022 02:29:04 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
11/19/2021 and conducted by Evaluator LaQueena Lacy

COMPLAINT CONTROL NUMBER: 31-AS-20211119123050

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: 68	DATE:	10/07/2022
		UNANNOUNCED	TIME BEGAN:	10:48 AM
MET WITH:	Staci Marmer		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility has bed bugs.
Facility Food is not healthy.
Facility did not provide incidental medical care to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) LaQueena Lacy conducted a subsequent visit on 10/07/2022 at 10:48am to deliver investigative findings for the above allegations. LPA met with Staci Mermar and explained the purpose of the visit.

LPA conducted a physical plant tour at 10:52am

It is alleged that a resident had bed bugs bites on them. To investigate the above allegation, LPA Lacy conducted interviews with staff and residents on 11/23/2021 between 11:19 – 11:35am and 07/25/2022 between 11:42am - 2:46pm. Five (05) out of seven (07) residents interviewed have not seen or heard of any bedbugs at the facility. During the investigation LPA inspected nine (09) random rooms on the first and second floor, instructed and observed staff to remove bed linens, comforters off beds, and unzipped mattress coverings. LPA inspected mattress seams, bed frames and did not observe any bed bugs or pests during the inspection.
Continued on 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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-20211119123050

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: 10/07/2022

NARRATIVE

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Upon record review of Dewey Pest Control Co. Quality Assurance Report the facility receives a monthly service to control general pest inside and around the perimeter of the building and other pest as identified. Based on LPAs interviews, observation, and record review, there is not enough evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED.

#2. Facility Food is not healthy.
It is alleged that the food is horrible and not healthy. To investigate the above allegation LPA interviewed seven (07) residents on 11/23/2021 between 11:19 – 11:35am and 07/25/2022 between 11:42am - 2:46pm. Five (05) out of (07) residents had lunch at the facility the day of the investigation, and stated “the food was good”, had no complaints regarding the food,
and that the food provided was healthy. LPA observed lunch served the day of the investigation to be of quantity, quality, and observed no complaints during lunch. Upon record review of the Monthly Food Service Inspection Report conducted by a dietician, confirmed the food is well accepted by residents, portion control followed, and substitutions or replacements are offered and appropriate. Based on LPAs interviews, observation, and record review, there is not enough evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED.

#3. Facility did not provide incidental medical care to resident.
It is alleged that a resident had bites on them. To investigate the above allegation interviews with six (06) out of seven (07) residents revealed they have not been bitten by any bugs or pest. Interviews with staff confirmed no one has complained about any bites or bugs in their room or on their persons. During the investigation LPA inspected nine (09) random rooms on the first and second floor and did not observe any bugs or pest. Based on LPAs interviews, observation, there is not enough evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited, Exit interview conducted, Copy of report and appeal rights issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC9099 (FAS) - (06/04)

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