197608280-2-22-2022-29-AS-JAPL-CBX3QL-20220223172720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 09/21/2021
Date Signed: 02/22/2022 12:45:01 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: 30	DATE:	09/21/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Ulka Sanghavi		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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

INVESTIGATION FINDINGS:

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This is an amended report. Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint investigation visit regarding the above noted allegations. During the initial visit on August 30, 2021 at 10:00 a.m., LPA Urena conducted a brief facility tour, and interviewed some residents in care. On this subsequent visit, Licensing Program Analyst (LPA) Sandra Urena, arrived at the facility at 1:30 p.m., and at 1:45pm, the LPA met with Administrator Melissa Christopher. LPA Urena explained the reason for the visit. LPA Urena conducted interviews between 11:00 a.m. and 3:00 p.m. with a random selection of residents and staff. In addition, the LPA requested minutes for the Residents Council Meetings, which were later reviewed.Regarding the allegation, ‘Resident does not feel safe at the facility’, it is alleged that the facility recently accepted two (2) male residents who have been heard making violent threats against other residents. One (1) of the two (2) new male residents allegedly made threats against facility staff as well and was allegedly removed from the facility. To investigate this concern, LPA Urena conducted interviews with residents who stated that they do not feel safe at the facility due to two (2) residents making threats against other residents; and, that these two (2) residents continue to reside at the facility.

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: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

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 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: 09/21/2021

NARRATIVE

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LPA Urena also interviewed a random selection of residents regarding whether or not they felt safe in the facility. The residents’ interviews revealed that they have not heard other residents making threats, nor have they witnessed residents being aggressive towards other residents. Additionally, randomly interviewed residents stated that they feel safe at the facility, in their rooms, and in the common areas of the facility; and, if they felt unsafe at the facility, they would bring it up to the administration. The staff’s interviews revealed that they have not witnessed any acts of threats or aggression between resident to resident or between residents to staff. Based on the investigation, there is insufficient evidence to support the claim that the facility is unsafe, which would lead residents to not feel safe at the facility. Therefore, the allegation is deemed Unsubstantiated at this time.
Regarding the allegation, ‘Staff failed to provide a safe and comfortable environment for residents in care’, it is alleged that on an unknown date, the facility held a resident council meeting with the residents. In this meeting, the complainant alleges that the alleged violent resident said in front of everyone that “if anyone goes to their room, they would kill or shoot them”. To investigate this allegation, LPA Urena conducted interviews with staff and a random selection of residents about the resident in question making threats during the Resident Council meeting. The residents interviewed revealed that they have not heard other residents making threats, nor have they witnessed anyone being aggressive at the Resident Council meeting. The residents stated that the Resident Council meetings are held in the dining room area with an open-door policy; and, the meetings dates are posted in the monthly calendar. The staff interviewed about the Resident Council meeting revealed that they have not heard residents making threats during the meetings. The staff stated that some residents tend to talk louder than other residents, but staff has not witnessed or heard threats from resident to resident. Staff reported that staff is present at the Resident Council meetings for support; and, to hear residents’ opinions and recommendations as a group. LPA Urena received a copy of the Resident Council Meeting Minutes for the month of August 2021. Upon review of these minutes, it was observed that the minutes did not reflect any notes addressing the allegation that the resident in question made threats to other residents during the Resident Council meeting. Resident council minutes are taken and recorded by council meeting officers attending the meeting. The council meeting officers are elected residents residing in the facility. The facility staff was not able to provide a sign-in sheet for the Residents Council minutes provided. Based on the investigation, there is insufficient evidence to support the allegation that staff failed to provide a safe and comfortable environment for residents in care. The allegation is deemed Unsubstantiated at this time. No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was issued via email.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021

LIC9099 (FAS) - (06/04)

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