<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609105
Report Date: 10/25/2023
Date Signed: 10/25/2023 03:22:36 PM

Substantiated


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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/19/2023 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20231019092238
FACILITY NAME:GRANDVIEW, THEFACILITY NUMBER:
197609105
ADMINISTRATOR:FLORES, YENIFACILITY TYPE:
740
ADDRESS:2211 W 6TH STREETTELEPHONE:
(213) 380-7000
CITY:LOS ANGELESSTATE: CAZIP CODE:
90057
CAPACITY:215CENSUS: 149DATE:
10/25/2023
UNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Yeni FloresTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff pushed resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Evelin Rios and Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPAs met with the administrator, Yeni Flores, and advised her of the complaint. Today's investigation consisted of interviews with the administrator and staff, record review, and a physical plant inspection.

Staff pushed resident:
In regards to the allegation, it was alleged that on or around 09/13/23, Staff 1 (S1) pushed Resident 1 (R1). R1 had to use a wall for support and then lunged at S1. Interviews with the administrator and staff reveal that in the late night on or around 09/13/23, R1 was becoming agitated, and knocking on the doors of the other residents. S1 tried to intervene and stop R1 from doing so, but during the course of their intervention, R1 was becoming aggressive towards S1 prompting S1 to move R1 aside. In addition, S1 stated they never put their hands on R1. Review of facility surviellance reveal that S1's arm was raised, and forearm made
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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 4
Control Number 31-AS-20231019092238
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GRANDVIEW, THE
FACILITY NUMBER: 197609105
VISIT DATE: 10/25/2023
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
contact with R1s body, causing R1 to lose balance and lean back against the wall. Additional interviews were held, and there was no reports of any injuries sustained to R1. Review of facility files reveal that S1 received training in Intervention on Aggression, Positive Resident Communication, and Harassment. Although S1 received training with intervention on resident aggression, surveillance video confirms that that S1 made physical contact with R1, causing R1 to lose their balance. Therefore, the allegation is Substantiated. Citation issued on the 9099D. Administrator advised and appeal rights given.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20231019092238
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GRANDVIEW, THE
FACILITY NUMBER: 197609105
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2023
Section Cited
CCR
87468.1(a)(1)
1
2
3
4
5
6
7
Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following: To be accorded dignity in their personal relationships with staff, residents and other persons. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
As POC, administrator will hold training to address this section of the regulation. As proof training is held, documentation with training log is due to the licensing agency by November 1, 2023.
8
9
10
11
12
13
14
LPAs received surviellance of an incident that occurred on or around 09/13/23, which reveals S1 pushing or making contact with R1, causing R1 to lose balance. This poses an immediate health and safety risk of the resident.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/19/2023 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20231019092238

FACILITY NAME:GRANDVIEW, THEFACILITY NUMBER:
197609105
ADMINISTRATOR:FLORES, YENIFACILITY TYPE:
740
ADDRESS:2211 W 6TH STREETTELEPHONE:
(213) 380-7000
CITY:LOS ANGELESSTATE: CAZIP CODE:
90057
CAPACITY:215CENSUS: 149DATE:
10/25/2023
UNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Yeni FloresTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not allowing resident to return to the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Evelin Rios and Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPAs met with the administrator, Yeni Flores, and advised her of the complaint. Today's investigation consisted of interviews with the administrator and staff, record review, and a physical plant inspection.

Staff are not allowing resident to return to the facility:
In regards to the allgation, it was reported that licensee is refusing to take Resident 1 (R1) back after hospitalization. Interview with the administrator deny the allegation. Interview with R1's case worker from Mental Health Intensive Case Management (MHICM) confirm that R1 was never unlawfully evicted. MHICM stated R1 is still currently at the hospital, with recommendation from their psychiatrist for R1 to be placed at an Institution for Mental Disase (IMD) facility at discharge. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not allowng R1 to return to the facility. Therefore, the allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4