197609342-4-23-2025-31-AS-TAGD-DGAT74-20250502142807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609342
Report Date: 04/23/2025
Date Signed: 04/23/2025 01:43:13 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 Gina Saucedo

PUBLIC

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: 114	DATE:	04/23/2025
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Maria Chengcuenca, Medical Technichian		TIME COMPLETED:	02:05 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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This is an addendum to the previous licensing report delivered to the facility on 07/02/2024.

On 04/23/25, at 9:35am, Licensing Program Analyst (LPA) Gina Saucedo conducted a subsequent visit to the facility to conduct additional investigation for the above noted allegations. LPA met with Maria Chengcuenca, Medical Technichian and explained the reason for the visit.

On 07/02/24, LPA Rosaura conducted an initial visit, interviewed staff and residents and delivered findings. On 04/23/25, LPA Saucedo asked for the census, staff, and resident rosters. On 04/23/25, LPA Saucedo conducted a physical tour and interviewed additonal staff, residents and received relevant documentation.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

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-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: 04/23/2025

NARRATIVE

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Regarding the allegation: Staff mismanaged resident's medication. It is being alleged that staff #1 (S1) was trying to over medicate and poison Resident #1 (R1). LPA received an Unusual Incident/Injury Report that states R1 was sent out to the community due to a 5150 hold on March 04, 2024 due to being a danger to self and others. Additionally, LPA obtained confirmation via the Medication Administration Record that R1 refused four (4) days of a medication that deals with treating schizophrenia prior to the incident on March 04, 2024. Two (2) staff confirmed that R1 was not taking their medication at the time of the incident and as a result their behavior had became worse. Four (4) staff confirmed that R1 would yell and scream from time to time. Eleven (11) residents were interviewed that confirmed they receive their medication and it is not mismanaged by staff. One (1) out of the eleven (11) residents that was R1's friend confirmed that R1 had episodes of yelling and screaming when they would not take their medication. Let it be noted, R1 had a bipolar disorder, anxiety and depression and was supposed to be taking several types of medication for these conditions. LPA obtained R1's Centrally Stored Medication and Destruction Record, Physician's Report, Preplacement Appraisal and Resident Appraisal, Appraisal Needs and Services Plan and the Medication Administration Record. Therefore, based on the LPA's record review, resident and staff interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not safeguard resident's personal belongings. It is being alleged that staff discarded Resident #1 (R1)’s personal belongings. During LPA's interview with R1, R1 stated that their belongings were taken to the Skilled Nursing Facility where they were staying. LPA interviewed two (2) of the staff that confirmed R1's belongings were taken to the Skilled Nursing Facility because R1 did not want to return to the above facility. LPA also interviewed R1's social worker and the social worker confirmed that R1's belongings were brought to the Skilled Nursing Facility and the belongings that were brought were in several boxes and were put in the basement for R1 until their transfer to another facility. LPA also obtained R1's Client/Resident Personal Property and Valuables that confirmed R1 did not entrust any values to the above facility signed by R1. Therefore, based on the LPA's record review, resident and staff interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

LIC 9099C-continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

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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: 04/23/2025

NARRATIVE

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Regarding the allegation: Illegal eviction. It is being alleged that the facility administrator illegally evicted Resident #1 (R1) and was transferred to a Skilled Nursing Facility. LPA interviewed R1 and R1 confirmed that they were not illegally evicted. R1 chose to not come back to the above facility because they felt they were being mistreated and the administrator had taken their belongings to the Skilled Nursing Facility. Furthermore, R1 confirmed that they asked their social worker not to bring them back to the above facility and instead look for a new place for them to live. Therefore, based on the LPA's resident and staff interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not treat resident with dignity and respect. It is being alleged that staff #1 (S1) did not treat Resident #1 (R1) with dignity and respect. LPA interviewed eleven (11) residents that confirmed S1 and/or other staff have treated them with dignity and respect. Furthermore, while interviewing residents, one (1) out of the three (3) residents that knew R1 stated that R1 told them they were going to burn the building down. Three (3) out of the eleven (11) residents confirmed that R1 yelled and screamed at them. Two (2) staff confirmed that they saw R1 walking down the hallway without clothes. Therefore, based on the LPA's resident and staff interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to Maria Chengcuenca, Medical Technichian.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

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