197608280-5-16-2023-29-AS-JAPL-CS7NEL-20230526102407

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 05/16/2023
Date Signed: 05/16/2023 05:38:45 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
05/12/2023 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 29-AS-20230512112322

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: 39	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Clarizze Punit		TIME COMPLETED:	05:50 PM

ALLEGATION(S):

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Staff threatened resident of eviction
Staff spoke inappropriately to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio conducted an initail 10-day complaint investigation to the above facility. LPA met with Administrator Clarizze Punit at 10:12 a.m. Entrance interview conducted.

On 05/12/2023, the Department received a complaint regarding staff threatened resident of eviction and staff spoke inappropriately to resident. On 05/16/2023, LPA Ascencio conducted an interview with Administrator Punit at 10:15 a.m. Interview with Administrator Punit revealed that Resident #1 (R1) has been living at the facility for over a year and is on the Assisted Living Waiver Program (ALW). Monthly, the ALW program pays a majority of R1's boarding and care fees, while R1 is responsible for what ALW does not cover. Administrator Punit stated R1 has not been paying their portion since moving in last year, raking up a fee of over $15,000. Administrator Punit also mentioned that they have spoke to R1 various time regarding the billing statement and possible eviction for non-payment, but was not mentioned in a threatening way. 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: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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-20230512112322

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: 05/16/2023

NARRATIVE

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We did have Staff #1 (S1) last week on 05/12/2023, to speak to R1. Although, I am not sure what was said, we could not hear any yelling or cursing coming from the room. I know that S1 was going to talk to R1 regarding their outstanding balance, and that the eviction topic would not come up. Lastly, R1 has been refusing to pay their portion stating the facility should be charging Medicare and Medi-Cal for their stay at the facility.

Later that same day, interview with R1 at 10:40 a.m., revealed that the facility has spoken to R1 various occasion regarding the billing. R1 added a staff person arrived at their room on 05/12/2023 talking about how they want to help me but then started to talk about getting "their money." Afterwards, that staff person began to yell at me and cursed at me, calling me a derogatory, racial slur. Lastly, R1 added that the staff person spoke to them about eviction because I havent paid, but R1 reiterated they will not be moving from the facility. That same day, interview with S1, starting at 11:20 a.m. revealed that they spoke to R1 on 05/12/2023 regarding ways the facility can assist R1 in obtained additional resources such as Social Security Income (SSI) funds. S1 stated the conversation was going great, until the topic of money and the outstanding balance came up. S1 added that R1 began to yell and curse at S1. S1 added they left the room not wanting to cause any emotional disturbance to R1. Lastly, S1 stated they were professional and understanding toward R1, and did not threatened R1 with any eviction. Later that day, interview with residents starting at 01:33 p.m. revealed that staff are nice, professional and have not cussed at any resident at the facility.

Although the R1 has an outstanding balance of $15,000 for not paying their portion of rent, interview with Administrator Punit revealed that the facility is looking at additional resources to help R1 obtain additional funds to create a payment plan for their balance. Administrator Punit stated they will not be evicting R1 at this moment as the facility wants to provide every resource available to R1 before doing so. Even though R1 stated they were called a racial slur by S1, and S1 stated they were professional and polite when speaking with R1, it is unsure what was actually said during the conversation between R1 and S1. Thus, there is insufficient evidence to prove that the allegation of Staff threatened resident of eviction and Staff spoke inappropriately to resident occurred. Thus, the allegations are deemed unsubstantiated at this time.

LPA Ascencio and Administrator Punit reviewed policies and procedures regarding the eviction process.

Exit interview conducted and copy of the report was issued to Administrator Punit.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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