197608200-10-26-2023-31-AS-NMAN-D5AQYY-20240515123556

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608200
Report Date: 10/26/2023
Date Signed: 10/26/2023 03:14:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
10/17/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20231017140458

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:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Stacy Marmershteyn		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are not providing a comfortable environment for resident
Staff did not prevent resident from threatening another resident

INVESTIGATION FINDINGS:

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At 12:00 p.m. on 10/26/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA toured the facility at 12:15 p.m., reviewed pertinent records at 12:30 p.m. including but not limited to medical assessments, functional capabilities assessments, preplacement appraisals, reappraisals, face sheets, admission agreements, government identifications, and needs and service plans, and interviewed three (03) facility staff members, two (02) case managers, and ten percent (10%) of residents, which equated to seven (07) out of seventy (70) residents, between 12:00 p.m. and 2:30 p.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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-20231017140458

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALTA VISTA GARDENS	FACILITY NUMBER: 197608200
	VISIT DATE: 10/26/2023

NARRATIVE

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Regarding the allegation “Staff are not providing a comfortable environment for resident” it was alleged that Resident #1 (R1) was unsafe at the facility. Staff interviews revealed that residents often yell at one another but typically resolve their issues peacefully. No staff recalled recent or notable instances of yelling resulting in physical violence. Staff #1 (S1) stated at 12:00 p.m. today that R1 often bothered other residents when R1 ran out of money or cigarettes. Resident #2 (R2), who is R1’s current roommate, stated at 12:40 p.m. today that they respect and get along with R1. Resident #3 (R3), who was R1’s previous roommate, confirmed at 1:25 p.m. today that R1 annoyed them, so the facility changed their living arrangements to accommodate both R1’s and R3’s comfort. Interview with R1 at 1:30 p.m. today revealed that R1 felt safe and comfortable at the facility. Based on interviews, there is insufficient evidence to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Staff did not prevent resident from threatening another resident” it was alleged R2 threatened to hurt R1. Interview with S1 at 12:00 p.m. today revealed the facility was not aware of any threats, and staff had not reported any threats. Interview with R2 at 12:40 p.m. today revealed they occasionally yell with R1, though the two get along overall. R2 stated they have never threatened R1. Interview with R3 at 1:25 p.m. today revealed they R3 never threatened R1. Interview with R1 at 1:30 p.m. today revealed that R1 got on R2’s nerves and R2 got on R1’s nerves. R1 stated that although they felt they engaged in verbal altercations with R2, R3, and other residents in the past, R1 stated that is how residents spoke to one another at the facility. Interview with Staff #2 (S2) at 1:15 p.m. today confirmed that the facility is aware of the manner in which residents yell at one another, but staff intervene when necessary. Interview with R1’s neighbor, Resident #4 (R4) at 1:45 p.m. today revealed R1 and R2 yell but are friendly and peaceful overall. Based on interviews, there is insufficient evidence to verify the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health or safety hazards were noted during the time of this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

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