197608280-8-8-2023-29-AS-KHEN-CUYVZS-20230823165312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 08/08/2023
Date Signed: 08/08/2023 06:27:24 PM

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
06/16/2023 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20230616132318

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:	ZIP CODE:	91607
CAPACITY:	49	CENSUS: 34	DATE:	08/08/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Ulka Sawghavi		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility food is not of good quality
Resident is being harassed by staff
Staff is refusing laundry services.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to the above facility. LPA Ascencio met with Ulka Sawghavi at 10:45 a.m. Entrance interview conducted.

On 06/16/2023, the Department received a complaint alleging that facility food is not of good quality, resident is being harassed by staff and that staff are refusing laundry services. On 06/19/2023, starting at 4:20 p.m., an interview with Resident #1 (R1) revealed that they do not have any complaints about the food being served. Additionally, the food is always delicious and nurturing. Lastly, R1 states that the food is great on most days, the other days, it is ok. Interview with six (6) residents on 06/26/2023 revealed that the food is good. The food comes from the skilled nursing facility (SNF) and is delivered to the residential dining room. The staff assist with plating the food and can serve the food at a hot temperature most of the time.

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: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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 3

Control Number 29-AS-20230616132318

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: 08/08/2023

NARRATIVE

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In addition, resident interviews indicated that they would prefer different variety of foods and meals instead of a rotating schedule. Lastly, although resident interviews indicated that they enjoy the food, other residents indicated that the food is cold, is of low quality and is not known what food item they are eating. That same day, starting at 11:00 a.m., LPA Ascencio conducted a tour of the facility kitchen. The tour revealed a clean and well maintained kitchen area with proper utensils and kitchenware. Additionally, LPA Ascencio observed a variety of perishable and non-perishable goods for resident consumption. During the kitchen tour, an interview with Head Chef revealed that they create a monthly dining calendar for the Assisted Living Facility and SNF. The menus involve a balanced meal consisting of protein, carbohydrates, and vegetables. The Head Chef added that if a resident does not like the food item on the calendar, they have a side menu they can choose consisting of sandwiches or salads. That same day, LPA Ascencio received menus for the month of June 2023 revealing all menus had a balance of protein, carbohydrates and vegetables for lunch and dinner. That same day, when conducting resident interviews, LPA Ascencio observed the lunch meals for 6 residents, which consisted of chicken in a red sauce, mashed potatoes, and cooked squash.

Although some resident interviews revealed that they were displeased with the food not being of good quality, observation and additional interviews revealed that the food is of good quality and enjoy what is being served daily. The LPA spoke with Staff Ulka regarding the request of resident wanting different variety and that food should always consists of good quality food types. Thus, based on evidence gathered, the allegation of facility food is not of good quality is deemed unsubstantiated at this time.

Regarding the allegation of resident is being harassed by staff. On 06/19/2023, starting at 4:20 p.m., an interview with R1 revealed that they are not being harassed by staff or residents. R1 indicated that they have not had a problem with anyone at the facility and if they do, they can reach out to the staff for assistance. Interview with six (6) residents on 06/26/2023, starting at 11:25 p.m. revealed that no staff member or other resident has harassed them at the facility. Additionally, residents are aware they can reach out to staff or the Administration for assistance if any harassment were to occur. That same day, interview with staff members revealed that they have not seen or heard of any resident being harassed by another staff or resident. Staff members indicated that they could reach out to their Administrator, call the Ombudsman or Community Care Licensing if abuse or harassment were to occur. Based on evidence gathered, the allegation of resident is being harassed by staff is deemed unsubstantiated
at this time.
Continued on LIC 9099 - C Page 2

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

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20230616132318

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: 08/08/2023

NARRATIVE

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Lastly, regarding the allegation of staff is refusing laundry services. On 06/19/2023, starting at 4:20 p.m., an interview with Resident #1 (R1) revealed that they wish to have their own personal laundry service done separately from everyone else. The facilities protocol for laundry services is collecting the dirty laundry from all residents and putting it to wash collectively. Right now, the washer stopped working, so the staff are taking the clothes to the other side, washing them, and drying them on our side. I just don’t want to have all my clothes together. They haven’t lost any clothes, but I don’t want mine with everyone else. That same day, an interview with Staff #1 (S1), starting at 4:30 p.m., confirmed that the washer stopped working, but because the staff have access to the SNF washer, they can continue with laundry services. S1 added that R1 has stated that they want to have their clothes done separately but gave us no reason for it. If R1 would be losing socks, shirts or pants, then maybe we would consider doing laundry service separately, but at this point in time, there is no need. R1 got upset at this gesture but we haven’t had an issue moving forward. Interview with six (6) residents on 06/26/2023, starting at 11:25 p.m. revealed that they do not have a problem with laundry services or services being denied. Additionally, residents confirmed that the washer is not working at the assisted living facility, but the staff have been getting it done on a daily basis. That same day, interviews with various staff members revealed that they do not refuse laundry services for residents. Additionally, staff indicated that the residents can request a specific outfit or clothing item to be washed, and if it is more than that, staff will not refuse and will wash their clothes. Lastly, staff indicated that R1 request their laundry be done separately from everyone else. Although the request was denied, staff indicated that they continue to provide laundry services for R1 and everyone at the facility.

Although R1 had requested staff to separate their laundry from the rest of the residents, further interviews with R1 and other residents revealed that the current process of laundry service is working. LPA Ascencio and Ulka spoke regarding the laundry service and reminded that all facility appliances should be fully operational and in good condition. Ulka added that the Maintenance Director is aware of the problem and are currently awaiting parts for repair. Based on evidence gathered through the investigation, the allegation of staff is refusing laundry services is deemed unsubstantiated at this time.

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

Page 3

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

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC9099 (FAS) - (06/04)

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