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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 09/28/2021
Date Signed: 09/28/2021 03:31:41 PM



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. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2021 and conducted by Evaluator Salia Walker
COMPLAINT CONTROL NUMBER: 29-AS-20210902165549
FACILITY NAME:FOUR SEASONS ASSISTED LIVING CENTER LLCFACILITY NUMBER:
197608280
ADMINISTRATOR:MELISSA CHRISTOPHERFACILITY TYPE:
740
ADDRESS:12120 CHANDLER BLVDTELEPHONE:
(818) 487-0770
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91607
CAPACITY:49CENSUS: 30DATE:
09/28/2021
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Ulka Sanghavi, Social Service DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility is discriminating against resident #1 (R1) by being rude to R1.
Facility administrator is violating resident #1's rights by not allowing R1 to obtain a copy of their medication log to share with R1's physician during their medical appointment.
The administrator is not qualified.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint visit to deliver the investigation findings for the above allegations. The LPA met with administrator Melissa Christopher at 09:10 a.m. and explained the reason for the visit.

During today’s visit, the LPA conducted a physical plant tour with the administrator from 9:40 a.m. until 9:45 a.m. to ensure there are no health and safety hazards. From 9:13 a.m. until 9:39 a.m., the LPA conducted an interview with the administrator. From 9:46 a.m. until 9:51 a.m.; and between 11:25 a.m. until 11:38 a.m., the LPA conducted interviews with staff. From 9:58 a.m. until 11:09 a.m., the LPA conducted interviews with residents. From 11:15 a.m. until 11:24 a.m., the LPA reviewed and obtained copies of documents pertinent to the investigation.

Continue on LIC9099C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
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 4
Control Number 29-AS-20210902165549
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FOUR SEASONS ASSISTED LIVING CENTER LLC
FACILITY NUMBER: 197608280
VISIT DATE: 09/28/2021
NARRATIVE
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On 09/07/21, LPAs Sandra Urena and Salia Walker conducted an initial complaint visit at 4:45 p.m. Between 5:00 p.m. and 5:35 p.m., the LPAs conducted interviews with residents. The LPAs determined, at that time, that further investigation was required.
Regarding the allegation, ‘Facility is discriminating against resident #1 (R1) by being rude to R1’, the complainant’s concern is that they believe that the administrator is racist. The complainant stated that R1 feels harassed and targeted because of R1’s race.
During the investigation, LPA Walker conducted interviews with the complainant, R1, the facility residents, and staff, to determine whether or not they have observed the administrator being rude to any facility resident, regardless of their race. Interviews with residents revealed that the residents have ‘never witnessed or observed the administrator being rude to anyone’, ‘race is not an issue’, the administrator ‘takes care of business’, ‘everyone here is treated equally, like family.’ Staff were interviewed as to whether or not they have observed the administrator being rude to any facility resident, regardless of their race. Interviews with staff revealed that ‘doesn’t matter what race,’ they have ‘never seen the administrator be rude to residents,’ the administrator ‘always listens to everyone and meets their needs,’ and ‘the residents are happy here.’
The LPA also interviewed the administrator who revealed that the facility has a ‘Zero Tolerance Policy’ regarding discrimination, ‘and if there is any discrimination between staff towards residents, staff will be reprimanded.’ The administrator did acknowledge that ‘there are times the office door is closed due to being in conference meetings at least once a week.’ The administrator also stated that she still ‘socializes with all the residents.’ The administrator stated the facility has ‘coffee with the administrator’ where the administrator sits with the residents to get to know each other and address any concerns the residents have.’
The LPA interviewed R1 to find out if R1 believes that the administrator is rude to R1 and what that entailed. R1 stated the administrator ‘has not said or done anything to R1 directly, but was informed by another resident the administrator picked on that resident.’ R1 did not give further information as to whether or not the administrator was observed by R1 being rude to any facility residents, regardless of their race. R1 only provided the information given to R1 by the other facility resident.
Based on interviews with the complainant, R1, facility residents, staff, and the administrator, there is insufficient evidence to support the allegation ‘Facility is discriminating against resident #1 (R1) by being rude to R1.’ Therefore, this allegation is deemed Unsubstantiated at this time.

Continue on LIC9099C..
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20210902165549
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FOUR SEASONS ASSISTED LIVING CENTER LLC
FACILITY NUMBER: 197608280
VISIT DATE: 09/28/2021
NARRATIVE
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Regarding the allegation, ‘Facility administrator is violating resident #1's (R1’s) rights by not allowing R1 to obtain a copy of their medication log to share with R1's physician during their medical appointment’, the complainant’s concern is that R1 asked staff to provide R1 with their medication log sheet to share it with R1’s doctor. According to R1, the staff requested R1’s medication log sheet from the administrator to give to R1, and the administrator refused to provide it.

During the investigation, LPA Walker conducted interviews with R1, and the administrator. The LPA also conducted a record review and obtained copies of documents pertinent to the investigation. The interview with R1 revealed that the administrator asked for R1’s doctor to request R1’s medication log in order for the administrator to release it, versus it just coming from R1. During the interview with the administrator, it was revealed that R1 was requesting a copy of R1’s medication log containing internal facility information; and, that the administrator provided such copy requested by R1 with the internal facility information concealed. The administrator provided the example to the LPA of how she concealed the internal facility information. According to the administrator, ‘R1 wanted the controlled narcotics sheet reflecting staff signatures.’ The administrator provided a copy of the received letter and email from R1 specifying that R1 wanted the dates that the facility staff provided medication assistance.

Based on interviews with resident and the administrator, there is insufficient evidence to support that the allegation ‘Facility administrator is violating resident #1's rights by not allowing R1 to obtain a copy of their medication log to share with R1's physician during their medical appointment. Therefore, the finding is deemed Unsubstantiated.

Regarding the allegation, ‘The administrator is not qualified’, the complainant’s concern is whether the administrator ‘is the right person for this spot.’ During the investigation on 09/07/21, LPAs Urena and Walker conducted an interview with the complainant. The interview with the complainant revealed that according to the complainant, they ‘never said [the administrator] was not qualified.’ The complainant stated, they ‘don’t know if she is qualified,’ and they don’t feel ‘she is the right person for this type of facility.’ The complainant believes the administrator ‘is not a people person’ because ‘she keeps her door closed,’ and the complainant believes the administrator ‘should come out of her office and get to know the residents.’

Continue on LIC 9099C..
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20210902165549
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FOUR SEASONS ASSISTED LIVING CENTER LLC
FACILITY NUMBER: 197608280
VISIT DATE: 09/28/2021
NARRATIVE
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To conduct the investigation, the LPAs reviewed the administrator’s ‘Certificate of Completion’ which reflected eighty (80) Hours of Residential Care Facility for the Elderly Initial Certificate Training Program completion. The LPAs also reviewed documentation regarding any other training that the administrator has received. The administrator provided a copy of the email by The Administrator Certification Section (ACS) congratulating on passing the Administrator Certification Exam as of 09/27/21. The LPA’s also interviewed facility staff and residents who viewed the administrator to be competent to do the job.

Based on record review, interviews with the complainant and the administrator, there is insufficient evidence to support that the allegation ‘The administrator is not qualified.' Therefore, the finding is Unsubstantiated.

Exit Interview conducted, a copy of the report was issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Salia WalkerTELEPHONE: 818-596-4379
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4