197608280-5-10-2021-29-AS-JAPL-C4C6M8-20210625205531

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 05/10/2021
Date Signed: 05/10/2021 02:00:43 PM

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
05/04/2021 and conducted by Evaluator Aja Richardson

COMPLAINT CONTROL NUMBER: 29-AS-20210504160210

FACILITY NAME:	FOUR SEASONS ASSISTED LIVING CENTER LLC		FACILITY NUMBER:	197608280
ADMINISTRATOR:	JOYCE ANN ALTAMIRANO		FACILITY TYPE:	740
ADDRESS:	12120 CHANDLER BLVD		TELEPHONE:	(818) 487-0770
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91607
CAPACITY:	49	CENSUS: 28	DATE:	05/10/2021
		UNANNOUNCED	TIME BEGAN:	11:28 AM
MET WITH:	Melissa Christopher, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility has a malodorous smell from the air-condition

INVESTIGATION FINDINGS:

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LIcensing Program Analyst (LPAs) Sandra Urena and Aja Richardson conducted an unannounced initial complaint investigation regarding the above allegation. LPAs met with the Administrator Melissa Christopher at 11:28am and explained the reason for the visit.

Regarding the above allegation there are concerns that there is an unidentified malordorous smell coming from the vent in Resident #1 (R1) room during the time the air conditioner unit is on. To investigate this allegation, LPAs conducted interviews from 11:30am to 12:40pm, with the administrator, staff, and a random selection of residents. During the facility tour at 11:30 am, LPA did not smell any odors. When the administrator and maintenance director checked R1's room on May 3th, no odors were detected. The administrator and maintenance director reported that the air conditioner unit was last checked on 5/4/2021 and reported everything to be in good working order. Interviews with the random selection of residents revealed that there were no reports of odors coming from the air conditioner and heating unit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

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-20210504160210

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: 05/10/2021

NARRATIVE

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During the record review conducted at 12:45pm LPA's reviewed the maintenance logs which revealed that on 5/4/2021, air filters and condense coils were replaced. In addition, although no odors were detected by staff or residents interviewed, in order to rectify the situation the maintenance director placed a cover over the vent in R1's room to prevent any odors from entering the room. Based on interviews conducted and record review residents in facility did not report any odors and the air conditioner units are checked on a monthly basis. At this time there is insufficient evidence that there is an odor coming from facility's air conditioning unit Based on this information this allegation is Unsubstantiated at this time.

Exit Interview Conducted. Report emailed to Administrator.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Aja Richardson	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

LIC9099 (FAS) - (06/04)

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