197608280-5-21-2021-29-AS-DPEA-C6E2TC-20210830174030

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608280
Report Date: 05/21/2021
Date Signed: 05/21/2021 02:50:35 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
12/18/2020 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20201218152245

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:	05/21/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Melissa Christopher - Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are not properly feeding the residents while in care

Staff do not keep the facility free from pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint investigation for the above allegation. LPA met with Administrator Melissa Christopher.

During the course of the investigation, LPA conducted a physical plant tour virtually on 12/23/2020 as well as interviewed Administrator. On 5/11/21 LPA conducted interviews with facility staff, residents and other relevant parties. LPA also gathered and reviewed facility documentation pertinent to the allegation.

Regarding allegation that staff are not properly feeding the resident while in care, information gathered through interviews of (10) residents revealed there were no immediate or major concerns regarding residents not being properly fed. LPA reviewed and obtained a copy of the facility menu and observed a variety of foods being served. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that staff are not properly feeding the residents while in care 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: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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-20201218152245

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: 05/21/2021

NARRATIVE

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Continued from 9099

Regarding the allegation that staff do not keep the facility free from pests, information gathered through interviews of (10) residents revealed that most residents have not witnessed pests, roaches or other vermin around the facility or in their rooms. Most residents believed there were no major concerns of infestations. Information obtained through records review also revealed that facility takes a proactive approach to prevent infestations as they get serviced by a pest control company every other month Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that staff do not keep the facility free from pests.

Exit interview conducted , report signed and issued 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: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

LIC9099 (FAS) - (06/04)

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