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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 08/19/2021
Date Signed: 08/19/2021 02:55:58 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
08/10/2020 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20200810165320
FACILITY NAME:FOUR SEASONS ASSISTED LIVING CENTER LLCFACILITY NUMBER:
197608280
ADMINISTRATOR:JOYCE ANN ALTAMIRANOFACILITY TYPE:
740
ADDRESS:12120 CHANDLER BLVDTELEPHONE:
(818) 487-0770
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91607
CAPACITY:49CENSUS: 29DATE:
08/19/2021
UNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Melissa Christopher - Administrator TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff failed to assist Resident #1 with the self-administration of medication
Staff #2 inappropriately interacts with residents
Facility did not consider food habits of residents in meal planning
Facility did not provide proper care to residents
Facility did not provide a safe and sanitary enviroment due to a lice outbreak
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint investigation for the above allegation. LPA met with Administrator Melissa Christopher.

During the course of the investigation, LPA conducted a physical plant tour virtually on 08/18/2020 as well as interviewed Administrator. On 5/11/21 LPA conducted interviews with facility staff, residents and other relevant parties. LPA also gathered and reviewed facility documentation pertinent to the allegation.

It was alleged that , Facility staff failed to assist Resident #1 with the self-administration of medication, LPA interview with Resident 1 (R1) revealed that they are satisfied with the assistance they receive from staff with medication. R1 did not express any immediate concerns for assistance with medication, and anytime R1 has had any concerns with their medication staff assist R1 with calling their doctor. LPA interview with Staff 1 (S1) revealed anytime R1 refuses to take medication , the Administrator informs R1s doctor.
Continued on 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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 3
Control Number 29-AS-20200810165320
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: 08/19/2021
NARRATIVE
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(Continued from 9099)

LPA interview with (10) residents revealed that all are satisfied with the assistance they receive from staff with their medications. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility staff failed to assist R1. Therefore the above allegation is UNSUBSTANTIATED at this time.

It was alleged that , Staff 2 (S2) inappropriately interacts with residents, LPA interview with (10) residents revealed that all residents did not express any concerns with their interactions with S2 All residents interviewed have also never witnessed S2 interact inappropriately with any residents in care. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that S1 inappropriately interacts with residents. Therefore the above allegation is UNSUBSTANTIATED at this time.

It was alleged that Facility did not consider food habits of residents in meal planning, LPA reviewed and obtained a copy of the facility menu and observed a variety of foods being served. LPA interview with (10) residents revealed that most believe there is a sufficient variety of food being served. LPA interview with Administrator revealed that kitchen staff have always been open to communication from residents regarding quality of food. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility did not consider food habits of residents in meal planning. Therefore the above allegation is UNSUBSTANTIATED at this time.

(continued on 9099-C)

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20200810165320
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: 08/19/2021
NARRATIVE
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(Continued from 9099-C)

It was alleged that Facility did not provide proper care to residents. LPA interview with (10) residents revealed that most residents believed they were receiving proper care from staff and most did not express any immediate concerns about the staff or the services they were receiving. LPA also received additional information that a resident in unit #211 was not receiving proper care, but physical plant tour revealed there is no unit #211 on the 2nd floor. Units on the 2nd floor begin at 215A. LPA interview with staff revealed #211 does not exist and the unit numbers that come close to that figure; unit 111 is not currently occupied and the resident in unit 221 does not match the description that LPA received. LPA records review of the facility files of the (4) residents who closest match the description on the 2nd floor revealed to be updated and sufficient at this time. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility did not provide proper care to residents. Therefore the above allegation is UNSUBSTANTIATED at this time.

It was alleged that Facility did not provide a safe and sanitary environment due to a lice outbreak, LPA interview with staff and (10) residents revealed that all are not aware of a lice outbreak ever occurring at this facility. LPA records review of pest control invoices revealed the facility has never been treated for a lice. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility did not provide a safe and sanitary environment due to a lice outbreak. Therefore the above allegation is UNSUBSTANTIATED at this time .

Exit interview conducted. Report issued and sent via email.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3