197608280-4-6-2022-29-AS-JAPL-CDDSNV-20220411140211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 04/06/2022
Date Signed: 04/06/2022 09:42:19 AM

Unsubstantiated

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
01/13/2022 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20220113145359

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: 37	DATE:	04/06/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Ulka Sanghavi		TIME COMPLETED:	09:50 AM

ALLEGATION(S):

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Facility staff are financially abusing resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit to deliver the findings for the above allegation. The LPA met with Social Worker/Administrator Assistant Ulka Sanghavi and explained the reason for the visit.

During the initial visit conducted on 1/19/2022, LPA Elsie Campos conducted an interview with the administrator at 3:45 p.m. The LPA reviewed and obtained copies of documents pertinent to the investigation. During a visit conducted on 4/1/2022, LPA Campos interviewed staff at 9:35 a.m., 1:00 p.m., 1:45 p.m., 1:57 p.m., and 2:20 p.m., reviewed documents at 9:40 a.m., conducted a brief plant tour at 10:40 a.m. and interviewed residents at 11:15 a.m. and 11:50 a.m.

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

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-20220113145359

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: 04/06/2022

NARRATIVE

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Regarding the allegation: Facility staff are financially abusing the resident

The complainant was concerned that the facility had taken thousands of dollars from Resident #1 (R1), and invoices were red flags. During the investigation, a record review revealed, that the facility has provided the resident with monthly invoices showing the correct amounts due for rent. The record review further revealed that the resident is past due however, all payments and invoices reflect the adequate amounts due since the resident’s admission into the facility. Interviews revealed that the resident was previously at a skilled nursing facility where they were undergoing financial hardship. Interviews with staff and the administrator indicated that all residents are provided alternatives to payment when residents are unable to meet their financial obligation. Staff and administrator negated any complaints or active matters regarding financial abuse.

Based on the information obtained, there is insufficient evidence to support the claim, that facility staff are financially abusing the resident. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC9099 (FAS) - (06/04)

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