197608280-9-27-2024-29-AS-KLOZ-DABVZP-20241023165303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 09/27/2024
Date Signed: 09/27/2024 02:10:22 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
09/20/2024 and conducted by Evaluator Erica Mosley

COMPLAINT CONTROL NUMBER: 29-AS-20240920151349

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: 32	DATE:	09/27/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Administrator, Clarizze Punit		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff are withholding mail from resident(s)

INVESTIGATION FINDINGS:

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At approximately 9:55am Licensing Program Manager (LPM) KaSandra Lopez, and Licensing Program Analyst (LPA) Erica Mosley conducted an initial 10-day complaint visit to investigate the above allegation. Upon arrival, LPM Lopez and LPA Mosley were greeted by Activities Coordinator/ Social Worker, Ulka Sanghavi who called the Administrator to inform them of the visit. The Administrator Clarizze Punit arrived later during the visit at 10:08am. The LPM and LPA met with Administrator and explained the reason for the visit.

On 09/20/2024, the Department received a complaint regarding the following allegation, Facility staff are withholding mail from resident(s). LPM and LPA toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations.

Report Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

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-20240920151349

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: 09/27/2024

NARRATIVE

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Report Continued from LIC9099..

On the allegation Facility staff are withholding mail from resident(s), it is the concern of the reporting party (RP) that Staff 1 (S1) is withholding mail from Resident #1 (R1). To investigate this complaint, LPM and LPA requested pertinent documents to the investigation. The LPM and LPA also conducted interviews with the Administrator, three staff members, and seven residents, including R1 between 10:12am to 11:30am.

Interviews with residents revealed that no other resident other than R1 had an issue with receiving mail. Residents stated they receive mail from staff in a timely manner and had no concerns regarding mail. Residents state that the only person they are aware of having any issues with mail is R1. Interviews with staff revealed that mail is passed out regularly and no resident, other than R1 has concerns receiving mail. During the interview with S1, S1 stated that mail is not withheld from any resident including R1. Staff interviews support that mail is monitored and passed out by staff regularly without any concerns of mail being withheld. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Facility staff are withholding mail from resident(s) is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report and appeal rights provided.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC9099 (FAS) - (06/04)

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