197608280-8-3-2023-29-AS-KHEN-CUHR36-20230808123926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 08/02/2023
Date Signed: 08/03/2023 07:32:16 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
06/13/2023 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20230613130839

FACILITY NAME:	FOUR SEASONS ASSISTED LIVING CENTER LLC		FACILITY NUMBER:	197608280
ADMINISTRATOR:	CLARIZZE PUNIT		FACILITY TYPE:	740
ADDRESS:	12120 CHANDLER BLVD		TELEPHONE:	(818) 487-0770
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91607
CAPACITY:	49	CENSUS: 35	DATE:	08/02/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Aaron Mayes		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to the above facility. LPA Ascencio met with Interim Administrator Aaron Mayes at 10:00 a.m. Entrance interview conducted.

On 06/13/2023, the Department received a complaint alleging that an illegal eviction had occurred. On 06/13/2023, LPA Ascencio conducted Staff #1 (S1) interview starting at 2:24 p.m. Interview with S1 revealed that Resident #1 (R1) was admitted to the hospital on 06/08/2023 due to having lower abdominal pain. At the facility, R1 was unfortunately becoming more dependent on the caregivers to do all activities of daily living (ADL).R1 needed to improve or move to a skilled nursing facility (SNF). When R1 was at the hospital, we did receive a call from a social worker indicating that R1 was ready for discharge. We recommended R1 go to a SNF, and when R1 is better, they can return to the facility. Lastly, S1 stated they did not issue an eviction notice as R1 is still paying rent until they are discharge from their system, that has yet to happen.
Continued on LIC 9099 - C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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-20230613130839

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: 08/02/2023

NARRATIVE

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LPA Ascencio reviewed the Four Season Assisted Living facility file and did not observe an eviction notice letter for R1. LPA Ascencio attempted various times to communicate with R1 but did not receive a call back. Additionally, LPA Ascencio conducted email and telephone calls to R1’ s hospital social worker but did not get a response. On 08/02/2023, LPA Ascencio conducted a file review on R1 revealing that R1 was discharged from the facility on 06/08/2023. That same day, interview with Interim Administrator Aaron at 12:20 p.m. revealed that any resident that is admitted to the hospital, that day becomes their discharge date. Because we don’t know when or if a resident comes back, that date they leave becomes their discharged date from Four Seasons.

Although R1 was admitted to the hospital due to abdominal pain, R1 did not return to the facility once they were discharged from the hospital. According to S1, R1 was admitted to a SNF and chose not to return to Four Seasons Assisted Living, thus moving out. Because of R1 chose not to return, there was no formal eviction notice issued to R1. Thus, based on evidence gathered, there is insufficient evidence to support the claim that an illegal eviction occurred. This allegation is unsubstantiated at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC9099 (FAS) - (06/04)

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