197608280-7-29-2024-29-AS-DPEA-D7Q5VB-20240731201718

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 07/29/2024
Date Signed: 07/29/2024 07:13:49 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
06/08/2023 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20230608083803

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: 34	DATE:	07/29/2024
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Clarizze Punit		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Financial abuse.
Staff have not ensured resident's dwelling lock/key operate properly.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver final findings for the above allegations. During today’s visit, LPA met with Administrator Clarizze Punit and explained the reason for today's visit.

On 06/08/2023, the Department received a complaint alleging “financial abuse” and that “Staff have not ensured resident’s (R1) dwelling lock/key operate properly”. It was alleged that R1 was confronted by administration staff and a rent bill for $15,820.98 was presented to R1 for the period from 9/8/2021-6/8/2023.

On 06/13/2023, LPA Angel A. conducted staff and resident interviews beginning at 1:00 p.m., conducted a facility tour starting at 01:20 p.m. and obtained pertinent document. LPA Angel A. conducted a subsequent visit on 08/08/2023. During this subsequent visit from approximately 12:45pm – 3:25pm, LPA reviewed additional records, met with staff and residents including R1. The interviews conducted did not reveal any financial abuse or room maintenance. (Continue to Lic9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024

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 3

Control Number 29-AS-20230608083803

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: 07/29/2024

NARRATIVE

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On 7/23/2024 at approximately 2:45p.m., LPA Chochian conducted a collateral visit to interview R1. R1 did not state being a victim of financial abuse or having any other issues while residing at the Four Season Assisted Living facility. R1 expressed wanting to go back to Four Seasons Assisted Living. R1 declined to answer any further questions and was very agitated. LPA spoke with two Social Workers and the current attending Licensed Vocation Nurse (LVN) from the Woodland Center regarding R1. Social Workers and attending LVN report that R1 is very aggressive and agitated most of the time therefore it is very hard to communicate with R1. LPA asked if R1 ever reported any financial abuse or any other issues to them about this facility and both Social Workers and attending LVN confirmed that R1 did not make any complaints to them about this facility.

LPA Chochian made a subsequent complaint visit to this facility today and met with facility Administrator and Ulka Sanghavi, Social Service staff. LPA discussed the financial abuse allegation and concerns. Between approximately 12:30pm-1:45pm, LPA toured facility conducted interview with (8) random residents.

Regarding “financial abuse” allegation – Interview conducted with R1, facility staff, and other potential witnesses did not reveal/confirm that R1 was a victim of financial abuse at this facility. Interviews revealed that R1 did not pay the facility rent since 10/2021 and statements were provided to R1 at the facility and mailed to mailing address on file. R1 refused to provide any information to LPA. Potential witness interviewed reported that facility provided R1 a statement with a balance statement for 15,820.98 on 4/1/2023 and prior to this date R1 was never told or provided a invoice/statement balance from facility. According to Administrator and facility Social Service staff, R1 was aware of the balance since no payment was made from 10/2021. Rent statements were provided by Administrator showing non-payment of rent since 10/2021 during today’s visit. No other residents reported any type of financial abuse.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Financial abuse” is deemed UNSUBSTANTIATED at this time.

Regarding allegation “Staff have not ensured resident's dwelling lock/key operate properly” – Interview conducted with R1, facility staff and other potential witnesses did not confirm/validate this allegation. R1 was asked about this allegation and R1 refused to answer any further questions and expressed wanting to return to this facility. (Continue to 9099c).

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230608083803

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: 07/29/2024

NARRATIVE

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Eight (8) random residents interviewed during today’s visit validated that their room door lock/key function properly. Staff interviewed reported that if there are any maintenance issues special with a resident’s lock/key for the room it is replaced immediately. Staff reported that R1 never reported that there was an issue with the room lock/key. Staff stated that they were made aware by a visiting nurse on 3/15/2024 that R1 needs a new key which was provided to R1 that same day.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Staff have not ensured resident’s dwelling lock/key operate properly” is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024

LIC9099 (FAS) - (06/04)

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