197609342-7-2-2024-31-AS-TAGD-DGAT75-20250502142808

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609342
Report Date: 07/02/2024
Date Signed: 07/02/2024 03:37:12 PM

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
06/28/2024 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20240628141803

FACILITY NAME:	LOS FELIZ GARDENS		FACILITY NUMBER:	197609342
ADMINISTRATOR:	SHAPIRO, NONNA		FACILITY TYPE:	740
ADDRESS:	205 E LOS FELIZ ROAD		TELEPHONE:	(818) 241-2273
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 112	DATE:	07/02/2024
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Nonna Shapiro, Administrator		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff mismanaged resident's medication

Staff did not safeguard resident's personal belongings

Illegal eviction

Staff did not treat resident with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Administrator Nonna Shapiro and explained the reason for the visit.

It was reported that staff mismanaged resident's medication. Resident #1 (R1) alleged that Staff #1 (S1) was trying to over medicate and poison them. To investigate this allegation on 07/02/2024, between 11:30am and 1:07pm, staff interviews were initiated. Interviews revealed that R1 was medication non-compliant. R1 refused to take medication and as a result their condition has became worse. Between 1:15pm and 1:45pm, facility records (physician's report, administrator notes, incident reports, 5150) were reviewed. Records confirmed what staff told LPA.

Based on interviews and records review there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

Continue on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

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 3

Control Number 31-AS-20240628141803

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: 07/02/2024

NARRATIVE

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It was alleged that staff did not safeguard resident's personal belongings. R1 alleges that facility staff threw away their belongings and placed them out in the street. To investigate this allegation between 11:30am and 1:07pm, staff interviews were initiated. Interviews revealed that on 03/14/2024, R1 received their personal belongings at the Skilled Nursing Facility (SNF) and they signed the inventory list as acknowledgement of having received them. Furthermore, Staff deny throwing away R1's personal belongings out on the street. Between 1:15pm and 1:45pm, facility records were reviewed. Records confirmed what staff told LPA.

Based on interviews and records review, there is not sufficient information to support this allegation. Hence, the allegation is UNSUBSTANTIATED at this time.

It was report that R1 was illegally evicted. To investigate this allegation, between 11:30am and 1:07pm, staff interviews were initiated. Interviews revealed that R1 was not evicted from the facility. Due to medication non-compliance, R1's condition became worse and had to be sent out of the community on a 5150 due to being a danger to self and others. R1 was discharged from the psychiatric unit on 03/11/2024 and was sent to a Skilled Nursing Facility (SNF) due to continuing to be medication non-compliant. On 07/01/2024, staff found out that R1 was no longer at the SNF and that they had been discharged to another board and care. Between 1:15pm and 1:45pm, facility records were reviewed. Records confirmed what staff told LPA.

Based on interviews and records review, there is not sufficient information to verify this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

It was alleged that staff did not treat resident with dignity and respect. To investigate this allegation, between 11:30pm and 1:07pm, staff interviews were initiated. Interviews revealed that staff treat all residents in care with dignity and respect. R1 was at times rude and disrespectful to staff and residents. R1 was constantly making threats to the community that they were going to burn the building down. Sometimes R1 even physically assaulted residents and staff. Between 1:15pm and 1:45pm, facility records were reviewed. Records confirmed what staff told LPA>

Based on interviews and records review, there is not sufficient information to support this allegation. Hence, this allegation is UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20240628141803

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: 07/02/2024

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	No health and safety issued noted at the time of this visit. Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC9099 (FAS) - (06/04)

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