197608280-9-21-2021-29-AS-JAPL-CBX3QM-20220223172720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 08/30/2021
Date Signed: 09/21/2021 03:03:36 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
08/25/2021 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20210825134726

FACILITY NAME:	FOUR SEASONS ASSISTED LIVING CENTER LLC		FACILITY NUMBER:	197608280
ADMINISTRATOR:	MELISSA CHRISTOPHER		FACILITY TYPE:	740
ADDRESS:	12120 CHANDLER BLVD		TELEPHONE:	(818) 487-0770
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91607
CAPACITY:	49	CENSUS: 29	DATE:	08/30/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ulka Sanghaui		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident does not feel safe at the facility
Staff failed to provide a safe and comfortable environment for residents in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day complaint investigation visit regarding the above noted allegations. At 10:00am, the LPA arrived at the facility. At 10:15am, the LPA met with Activities Director, Ulka Sanghaui. Administrator Melissa Christopher was out on this day.

Starting at 11:00am, the LPA interviewed residents. The following narrative addreses the allegations above.

Regarding the above allegation: Resident does not feel safe at the facility
Residents stated that they feel safe at the facility. If at anytime they dont feel safe they would address it and speak their mind. Residents feel safe at the facility, in their rooms and common areas.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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 2

Control Number 29-AS-20210825134726

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: 08/30/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation: Staff failed to provide a safe and comfortable environment for residents in care

Residents stated that they feel safe and comfortable at the facility. Residents stated that they have a new Activities Director and the Activities Director has new and fun activities for them. The residents stated that the food has improved, and overall the facility is safe. The front door is locked at all times, and visitors have to ring bell to be admitted into facility. Residents have not heard anyone making threats, nor have witness anyone being aggressive at Residents' Council meeting.

Records Review:

The Activities Director left at 3:00pm. The LPA was not able to obtain the Residents’ Council Minutes for July, and August 2021 at time of visit for review. Needs further investigation.

An Exit Interview was conducted via telephone with Administrator Melissa Christopher. The report was emailed to the administrator, and the administrator agreed to sign and email the report back within 24 hours.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2