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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609342
Report Date: 04/29/2025
Date Signed: 04/30/2025 07:55:05 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
09/04/2024 and conducted by Evaluator Leizl De La Cerra
COMPLAINT CONTROL NUMBER: 31-AS-20240904125603
FACILITY NAME:LOS FELIZ GARDENSFACILITY NUMBER:
197609342
ADMINISTRATOR:SHAPIRO, NONNAFACILITY TYPE:
740
ADDRESS:205 E LOS FELIZ ROADTELEPHONE:
(818) 241-2273
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: 109DATE:
04/29/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Krystie Kim, Business OfficeTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Facility staff interfered with resident's medical care.
INVESTIGATION FINDINGS:
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This is to amend the report that was delivered on 1/29/2025.
Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced subsequent complaint visit on 4/30/25 to this facility to investigate the above allegation. At 11:00am LPA met with Krystie Kim and explained the reason for the visit.

Regarding the allegation: Facility staff interfered with resident's medical care.
It was alleged that facility staff (S1) coerced resident #1 (R1) by interfering and discouraging R1 and R1's medical case managers (W1 and W2) to stop R1's planned surgery scheduled for 9/05/24.
To investigate this allegation on 9/11/2024 LPA de la Cerra requested pertinent documents relevant to the investigation at 11:00AM, conducted and interviewed staff between 11:30PM to 2:30PM, reviewed records from 11:00AM to 12:30AM and conducted physical plant tour at 2:00PM with staff member. On 01/29/25, at 11:00am LPA de la Cerra asked for additional facility records included but not limited to; staff schedule, residents roster, R1’s facility records, medical information and other pertinent documents. From 1:00pm to 2:30pm LPA conducted interviews with twelve (12) residents and a third-party witness present at the facility.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
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 2
Control Number 31-AS-20240904125603
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LOS FELIZ GARDENS
FACILITY NUMBER: 197609342
VISIT DATE: 04/29/2025
NARRATIVE
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LPA de la Cerra’s interviews two (2) out of two (2) staff members, S1 and S2 revealed that staff members did not coerce R1 to stop or postpone the scheduled surgery. R1 was only informed of the possible complications of the surgery and R1 showed signs of hesitation in going forward with the surgery. Furthermore, the night before (which was 9/04/24) of the scheduled surgery date of 9/05/2024, R1 informed S2 that they wanted to proceed with their scheduled surgery. S2 provided help and assistance to R1 so all arrangements can be made for R1 to be delivered to the hospital on 9/05/24. On 12/06/24 LPA contacted R1 by phone, R1 verified and confirmed the information revealed from staff S1 and S2.

Interviews with residents revealed they never encountered any issues with facility staff interfering with any previous or future medical care, scheduled appointments or medical care needs.
A review of records also verified the information revealed from staff and R1. Facility records contain a note handwritten and signed by R1 deciding to hold off on the surgery.
Based on the inspection, observations, interviews, and record reviews there is no sufficient information to verify validity of the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
No deficiency cited during today's visit.
Exit interview conducted and copy of this report was signed and delivered.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
LIC9099 (FAS) - (06/04)
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