197608280-4-6-2022-29-AS-JAPL-CDDSMV-20220411140034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 04/06/2022
Date Signed: 04/06/2022 09:40:48 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
12/23/2021 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20211223133434

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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Lack of supervision results in verbal abuse and bullying amongst residents.

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 12/28/2021, LPA’s Salia Walker and Elsie Campos conducted a brief facility tour at 10:22 a.m., interviewed administrator at 10:36 a.m., interviewed staff at 11:05 a.m., interviewed resident at 11:25 a.m. and reviewed documents at 12:20 p.m. During a visit conducted on 3/30/2022, LPA Elsie Campos conducted an interview with the administrator at 12:20 p.m., collected documents at 12:50 p.m. and reviewed documents at 2:15 p.m. 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-20211223133434

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: Lack of supervision results in verbal abuse and bullying amongst residents.

It was alleged that Resident #1 was bullying and verbally abusing other residents at this facility due to lack of supervision. To investigate, the LPA conducted interviews with residents and staff. Interviews revealed that staff interact appropriately with residents at this facility and take effective action when there is knowledge of any conflicts between residents. Interviews negated claims that staff was not supervising residents and failed to act when residents required intervention. Interviews revealed that staff will attempt to resolve any disagreements between residents when there is knowledge of such behavior before taking any action, such as moving a resident out of a shared living space and into another space. The administrator did reveal that in the occasion where residents were not able to come to an agreement regarding their differences and living in the same room was no longer an option, they would take effective action to ensure that the residents are separated and their needs are met. Interviews revealed that staff intervened when they gained knowledge that R1 was interacting inappropriately with residents. Attempts by staff and the Administrator were made to diffuse escalating conflicts between R1 and other residents. Interviews with residents indicated that while they have witnessed some residents acting disorderly, that behavior is not common among residents. Interviews further revealed that R1 was assisted in bringing resolution to the ongoing conflicts between R1 and the other residents.

Based on the information obtained, there is insufficient evidence to support the claim that Lack of supervision results in verbal abuse and bullying amongst residents. 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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