197608280-5-14-2021-31-AS-DPEA-C5365U-20210718203056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 05/14/2021
Date Signed: 05/14/2021 03:17:20 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
04/17/2020 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 31-AS-20200417155546

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:	05/14/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Melissa Christopher - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Food is not of good quality

Facility exposed resident to harmful chemicals/cleaning products

The facility is not maintained in good repair (leaky window in resident room)

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Brian Balisi initiated a subsequent complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically at 2:50pm with Melissa Christopher, the facility administrator.
During the investigation, LPA conducted a physical plant tour virtually on 4/24/2020 as well as interviewed Administrator and Resident 1 (R1). On 5/11/2021, LPA conducted interviews with facility staff, residents and other relevant parties. LPA also gathered and reviewed facility documentation pertinent to the allegation.

In regard to the allegation that food is not of good quality, information gathered through interviews of (10) residents revealed there were no immediate or major concerns regarding food service. LPA reviewed and obtained a copy of the facility menu and observed a variety of food being served. Based on the information gathered during this and pervious visits, the department does not have sufficient evidence to determine that food is not of good quality. Therefore, the above allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

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 31-AS-20200417155546

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: 05/14/2021

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

Continued from 9099

In regard to the allegation that facility exposed resident to harmful chemical / cleaning products, information gathered through interview with staff and records review revealed that the cleaning product that was used is currently approved by the United States Environmental Protection Agency. Interviews with (10) residents further revealed that they all most were aware what cleaning products were used and have been informed ahead of time when their rooms are getting cleaned. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility exposed resident to harmful chemical / cleaning products. Therefore, the above allegation is UNSUBSTANTIATED at this time.

In regard to the allegation that the facility is not maintained in good repair (leaky window in resident room), information gathered through firsthand observation of the window in R1s bedroom did not reveal window to be in disarray at this time. Interview with R1, also revealed that they can’t confirm the last time they observed a leak coming from the window or if a leak ever came from the window. LPAs observation of the windows of (10) residents interviewed during this investigation revealed windows to be properly maintained at this time. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine the facility is not maintained in good repair. Therefore, the above allegation is UNSUBSTANTIATED at this time.

Exit interview conducted with Administrator, report issued and sent via E-Mail.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2