197608280-7-1-2021-29-AS-JAPL-C5ZREY-20210818125819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 07/01/2021
Date Signed: 07/01/2021 04:40:38 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
06/23/2021 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20210623152148

FACILITY NAME:	FOUR SEASONS ASSISTED LIVING CENTER LLC		FACILITY NUMBER:	197608280
ADMINISTRATOR:	MELISSA CHRISTOPHER		FACILITY TYPE:	740
ADDRESS:	12120 CHANDLER BLVD		TELEPHONE:	(818) 487-0770
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91607
CAPACITY:	49	CENSUS: 28	DATE:	07/01/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Melissa Christopher		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Residents are not allowed access to common areas of facility.
Staff do not provide activities for the residents.
Staff are not preventing residents from intimidating other residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted an announced complaint investigation visit regarding the above noted allegations. At 11:50 am LPA arrived at the facility. At 12:15pm, LPA met with Administrator Melissa Christopher. LPA explained the reason for the visit.

Regarding the above allegations, LPA requested the following records to address the allegations from RP: Activity Calendar, Residents Activity Participation Sheet, Residents’ Council sign in sheet. To investigate this allegation, LPA conducted interviews between 11:50 pm to 3:00 pm with the Administrator, RP Activities Director, Ombudsman, and a random selection of residents.

Regarding the allegation: Residents are not allowed access to common areas of facility.
At 12:30pm, LPA interviewed four residents about the use of the common areas, such as the dining room area, activity area, and outdoor area.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

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-20210623152148

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: 07/01/2021

NARRATIVE

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Residents expressed that areas are open to all residents to use. One of the residents was a resident who smokes. Resident stated that resident uses the patio area at least eight times a day to smoke. Three residents stated that they don’t use the patio area too often, but use the dining room area.

Based on the investigation, there is insufficient evidence to support the claim that Residents are not allowed access to common areas of facility.Therefore, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff do not provide activities for the residents.

At 2:00 pm LPA interviewed Activities Director. Activities Director provided two Activity Calendars for the months of May and June 2021. Calendars provide information about daily activities such as Socials, Bingo, Monthly Birthday Celebrations, Outings, etc. Additionally, Activities Director provided Resident’s Activity Participation logs for five residents for the months of May and June 2021.

Three residents were interviewed about the activities provided by the facility. The residents expressed that in the past they used to have many activities, but they stopped during the COVID outbreak. The activities have begun again, but not as many as before. Residents spoke about the Mother’s Day celebration, and birthday celebrations. They talked about having live music and outings to the park, playing bingo and cards.

Based on the investigation, there is insufficient evidence to support the claim that the facility does not provide activities for the residents. Therefore, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff are not preventing residents from intimidating other residents.

LPA interviewed four residents in connection to this allegation. The residents interviewed stated that they have not felt intimidated by other residents, however if they did, they would bring it up to the Administrator. The residents expressed they feel comfortable attending activities.

At 1:00 PM a Residents Council meeting took place in the dining room area. The Administrator, and the Activities Director were present. The meeting was to address the food complaints by residents. About 12 residents present during this meeting.

Based on the investigation, there is insufficient evidence to support that staff are not preventing residents from intimidating other residents. Therefore, this allegation is deemed Unsubstantiated at this time.

No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was issued via email.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

LIC9099 (FAS) - (06/04)

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