197608280-3-7-2024-29-AS-KHEN-D3SLTT-20240328090252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 03/07/2024
Date Signed: 03/07/2024 01:26:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
01/03/2022 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20220103090532

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: 29	DATE:	03/07/2024
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Clarizze Punit, Administrator		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident not accorded dignity in relationships with staff.
Resident not free from intimidation and/or other actions of a punitive nature.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Emily Peraldi conducted a subsequent visit to this facility today to deliver findings. At 11:25 a.m., the LPA met with and explained staff, Ulka Sawghavi reason for the visit. At 12:45 p.m., the Administrator, Clarizze Punit arrived at the facility.

During the initial visit on 01/11/2022 between 10:15 a.m. and 12:00 p.m., LPA Salia Walker conducted an interview with one (1) staff and the Administrator at the time, Melissa Christopher. On 01/11/2022, LPA Walker also reviewed and obtained copies of pertinent documents. On 04/01/2022, LPA Walker conducted a subsequent visit between 9:30 a.m. and 3:30 p.m. and during the subsequent visit, LPA Walker conducted a physical plant tour, interviewed residents and facility staff. During today’s visit on 03/07/2024, starting at 11:39 a.m., LPA Peraldi along with the staff conducted a physical plant tour. During todays visit, between 11:40 a.m. and 12:16 p.m., LPA Peraldi conducted interviews with seven (7) out of twenty nine (29) residents and three (3) staff. On 03/07/2024, at 12:46 p.m., the LPA conducted an interview with the Administrator, Clarizze Punit. Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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 2

Control Number 29-AS-20220103090532

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FOUR SEASONS ASSISTED LIVING CENTER LLC	FACILITY NUMBER: 197608280
	VISIT DATE: 03/07/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegations: Resident not accorded dignity in relationships with staff. It was alleged that Staff #1 (S1) was being disrespectful to Resident #1 (R1). Resident not free from intimidation and/or other actions of a punitive nature. It was alleged that S1 intimidated R1 and threaten to evict R1. Per record review, on January 2, 2022, R1 and S1 had a verbal altercation where R1 believed that S1 called R1 a “bitch” and R1 became aggressive towards S1. According to internal notes from the facility, S1 told R1 that R1 has been “aggressive and unwelcoming to new residents by constantly shouting and embarrassing them at lunch time and that it would be best to have better manners in the community to avoid an eviction.” During the course of the investigation, it was revealed that S1 does not work at the facility anymore. Resident interviews revealed that residents don’t have a problem with any staff members at the facility. Interviews with multiple residents revealed that staff treat residents with respect and dignity. Furthermore, interviews with multiple residents did not reveal any concerns regarding resident feeling intimidated by staff. Resident interviews revealed that residents feel safe at the facility. Interviews with the Administrator and various staff revealed that there have not been any recent issues between staff and residents. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed Unsubstantiated at this time.

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

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2