197609342-8-2-2021-28-AS-CYEE-C8N6BH-20211110193959

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609342
Report Date: 07/30/2021
Date Signed: 08/02/2021 05:34:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/08/2021 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210708092840

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: 146	DATE:	07/30/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Christy Kim, Business Manager		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Resident's funds are being inappropriately handled.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicole Spencer conducted a subsequent visit to deliver the findings for the allegation listed above. LPA Spencer was met by the business manager Christy Kim and explained the purpose of today's visit.

The investigation consisted of the following: During the initial visit on 7/12/21, LPA Spencer interviewed the administrator, staff #1-2 (S1-S2), and residents #1-5 (R1-R5). During the subsequent visit on 7/30/21, LPA Spencer interviewed residents #6-15 (R6-R15). Interview with R7 was discontinued because resident was non-verbal, so a total of 14 residents were interviewed. LPA obtained copies of the staff roster, resident roster, admissions agreement and rent receipts for two specified residents and safeguarded cash resource form for three specified residents.

***See LIC9099C for continuation of this narrative.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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 28-AS-20210708092840

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LOS FELIZ GARDENS	FACILITY NUMBER: 197609342
	VISIT DATE: 07/30/2021

NARRATIVE

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The investigation revealed the following: Regarding the allegation that resident's funds are being inappropriately handled, all staff interviewed denied the allegation. Staff stated that residents' safeguarded cash resources are documented and signed for, and all rent payments are documented through rent receipts. Residents are provided rent receipts upon request. 12 out of 14 residents interviewed stated that they have no concerns with how the facility handles their funds. Regarding the incident on 7/8/21, S1 stated that S1 took R4 to the bank to withdraw money to pay rent because the facility provides transportation for residents. S1 went inside the bank to assist R4 to withdraw money for rent but was denied by bank because R4's ID and debit card was expired. S1 stated that the bank provided temporary checks for resident which allowed the resident to pay rent.

LPA Spencer reviewed the admissions agreement showing that residents have a set amount of rent to pay each month. A review of the rent receipts reveals that R4 pays the correct amount listed in the admissions agreement. LPA reviewed safeguarded cash resources for three specified residents, showing that withdrawals by the resident are documented and signed for by both the resident and facility staff with the balance updated.

Based on interviews and records reviewed, the investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

There were no deficiencies cited. An exit interview was conducted and a copy of report was provided to the business manager.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC9099 (FAS) - (06/04)

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