197609105-8-23-2021-31-AS-CHAS-C6XW4E-20210917165725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609105
Report Date: 08/23/2021
Date Signed: 08/23/2021 12:17:45 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2021 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20210813133024

FACILITY NAME:	GRANDVIEW, THE		FACILITY NUMBER:	197609105
ADMINISTRATOR:	FLORES, YENI		FACILITY TYPE:	740
ADDRESS:	2211 W 6TH STREET		TELEPHONE:	(213) 380-7000
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90057
CAPACITY:	215	CENSUS: 149	DATE:	08/23/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yeni Flores		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Residents are smoking in their rooms

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced initial (10) day complaint visit and met with Administrator Yeni Flores. The following was determined:

It is being alleged that residents are smoking in their rooms. From 930am to 1145am, LPA conducted interviews, and made visual observations of residents and the physical plant, which included the common areas, the front entrance, and the inside patio. LPA observed residents smoking outside the front entrance, and other designated smoking areas. According to the information obtained, it was confirmed by the Administrator that there was a resident that was recently caught smoking in the room. The Administrator reported to LPA, there was a discussion with the resident, who was instructed to not smoke in the room. The resident has complied and has been seen smoking in the designated areas.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

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 4

Control Number 31-AS-20210813133024

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: 08/23/2021

NARRATIVE

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Also through interviews, resident # 1 (R1) confirmed smoking in the room. It was also reported to LPA, there have been previous issues with other residents smoking in the room; those issues have been resolved. Although the Administrator has confirmed residents have smoked in their rooms, it is known, it is a violation of the facility’s house rules and the Administrator continues to address the issue. This poses a potential health and safety risk to residents in care. Therefore, based on interviews, the allegation, “Residents are smoking in their rooms” is SUBSTANTIATED.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20210813133024

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: 08/23/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/30/2021 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities:(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2)To be accorded safe, healthful comfortable	1 2 3 4 5 6 7	Administrator will continue to monitor residents who are observed smoking in the rooms and will have a contract signed that violation of that policy will constitute a consequence. LPA
	8 9 10 11 12 13 14	accommodations..This requirement was not met, evidenced by: Interviews revealed residents have been caught smoking in their rooms. This is a potential health and safety risk to resident in care.	8 9 10 11 12 13 14	obtained a notice that will be provided to the resident for violation of the policy. POC cleared at the visit.
	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: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

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
08/13/2021 and conducted by Evaluator Tuesday Cabiness

COMPLAINT CONTROL NUMBER: 31-AS-20210813133024

FACILITY NAME:	GRANDVIEW, THE		FACILITY NUMBER:	197609105
ADMINISTRATOR:	FLORES, YENI		FACILITY TYPE:	740
ADDRESS:	2211 W 6TH STREET		TELEPHONE:	(213) 380-7000
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90057
CAPACITY:	215	CENSUS: 149	DATE:	08/23/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yeni Flores		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident developed rashes while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced initial (10) day complaint visit and met with Administrator Yeni Flores. The following was determined:

Concerns were expressed that a resident developed a rash while in care. From 1130am to 1230pm, LPA conducted interviews, and reviewed resident file information. According to the information obtained, it was confirmed, that resident (R1) had developed a rash that was from an unknown origin. There was no documentation revealed by the Administrator that the rash was from any source involving the facility and from other residents. R1 is currently being treated by a physician and under medical care. Based on documentation and interviews, there is insufficient evidence to conclude or identify the allegation “Resident developed rashes while in care”. Therefore, the allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

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