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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608200
Report Date: 10/07/2022
Date Signed: 10/07/2022 02:27:40 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
07/15/2022 and conducted by Evaluator LaQueena Lacy
COMPLAINT CONTROL NUMBER: 31-AS-20220715173601
FACILITY NAME:ALTA VISTA GARDENSFACILITY NUMBER:
197608200
ADMINISTRATOR:STACI MARMERSHTEYNFACILITY TYPE:
740
ADDRESS:829 NORTH ALTA VISTA BLVD.TELEPHONE:
(323) 937-1940
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:70CENSUS: 68DATE:
10/07/2022
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Staci MarmerTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff shoved resident.
Staff not assisting resident to the bathroom.
Staff not allowing resident to be interviewed.
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 Marmer and explained the purpose of the visit.

LPA conducted a physical plant tour at 10:52am

It is alleged that that resident #1 (R1) was shoved by escorts during a mobile clinic at the facility. To investigate the above allegation, LPA interviewed staff and residents on 07/25/2022 between 11:42am - 2:10pm. During the investigation R1 revealed that staff did not shove or tell R1 to stop talking. Interviews with six (06) out of (06) residents confirmed that no staff have shoved, or told any residents to stop talking. They have not witnessed or heard of any staff mistreating any resident. Interviews with staff confirmed that that no residents complained of any staff shoving them. Based on LPAs interviews, observation, there is not enough evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED.
Continued on LIC9099C.
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)
Page: 1 of 2
Control Number 31-AS-20220715173601
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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#2. Staff not assisting resident to the bathroom.

It is alleged that that resident #1 (R1) cited example of not being assisted to the bathroom. To investigate the above allegation, LPA interviewed staff and residents on 07/25/2022 between 11:42am - 2:10pm. During the investigation five (05) out of six (06) residents confirmed they are assisted with ADLs and have no issues when needing assistance. Upon record review R1 is able to care for own toileting needs, and is able to communicate needs. Based on LPAs interviews, observation, and record review, there is not enough evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED.

#3. Staff not allowing resident to be interviewed.

It is alleged that staff told resident #1 (R1) to stop talking when complaining about the facility. During the investigation R1 revealed that staff had not yelled or told R1 to stop talking during the mobile clinic at the facility. Interviews with six (06) out of (06) residents on 07/25/2022 between 11:42am - 2:10pm confirmed that no staff had yelled or told any resident to stop talking. 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)
Page: 2 of 2