197609105-10-15-2021-31-AS-NMAN-C7XU9B-20211019152248

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609105
Report Date: 10/15/2021
Date Signed: 10/15/2021 04:00:12 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
08/31/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210831085127

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: 147	DATE:	10/15/2021
		UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Yeni Flores - Administrator		TIME COMPLETED:	01:39 PM

ALLEGATION(S):

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Facility is receiving payments for a resident no longer in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with administrator Yeni Flores and explained the reason for the visit.

LPA conducted physical plant tour at 9:45 AM, requested facility documents relevant to the investigation at 10:15 AM and interviewed the administrator at 10:45 AM. Regarding the allegation that Facility is receiving payments for a resident no longer in care, it was alleged that the facility is still receiving payments for Resident #1 (R1)'s Social Security Administration (SSA) benefits. LPA's record review 09/02/21 at around 2:40 PM and today at 11:37 AM, revealed that R1 left the facility on 07/01/2020 and SSA benefits checks for R1 were sent to the facility until September of 2021, but were returned to the SS Administration with acknowledgement receipt that they received the returned check. LPA's interview with the administrator today at 12:05 PM, revealed that once a resident or any person has assigned a payee, SSA do not change the payee until that resident or person designate another payee, hence, the continuation of payment to the facility. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

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 31-AS-20210831085127

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: 10/15/2021

NARRATIVE

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(continued from LIC 9099)

LPA's interview with the Reporting Party (RP) on 09/15/2021 at 9:30 AM, revealed that R1 is currently in a mental health unit and was not able to to explain to the RP what was going nor R1 remembered anything about own SSA Benefits.

Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

LIC9099 (FAS) - (06/04)

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