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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609342
Report Date: 10/08/2021
Date Signed: 10/08/2021 04:11:02 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
10/01/2021 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211001152500
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: 134DATE:
10/08/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Nonna Shapiro TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff are rationing food for the residents while in care.
Staff are limiting the residents liquid consumption while in care.
Resident is being charged for services not received.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nicol Wesley conducted an initial complaint visit at the facility regarding the allegations listed above. LPA Wesley completed the risk assessment for on-site inspections with Kristine Baesa and met with Licensee/Administrator Nonna Shapiro and Kitchen Manager/Assistant Administrator Lusine Hakobyanan and the purpose for today’s visit was discussed.

The investigation consisted of the following: LPA Wesley interviewed residents #1-#5(R1-R5), Licensee Shapiro, and Kitchen Manager Hakobyan : LPA requested copies of the following documents: staff roster, resident roster, and the facility food menu. LPA Wesley also toured the facility kitchen, dining room, and observed the supply of perishable and non perishable food.

Regarding allegation: Staff are rationing food for the residents while in care. LPA Wesley interviewed facility residents and there were 4 out of 5 residents who said they are very pleased with the facility food, likes how the
Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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-20211001152500
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: 10/08/2021
NARRATIVE
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food tastes, receive a good portion of food being served, and are able to receive seconds or alternate food items if there aren't any leftovers. LPA Wesley interviewed Kitchen Manager Hakobyan who advised that the residents have never complained about the amount of food being served as they plate a good portion of food and the residents are allowed additional servings if they are still hungry. The Kitchen Manager also advised that they have an alternate menu if the residents do not wish to eat items served on the food menu. The investigation revealed that there is no sufficient evidence to support the allegation that staff are rationing food for the residents while in care.
Regarding allegation: Staff are limiting the residents liquid consumption while in care. LPA Wesley interviewed residents and there were 4 out of 5 residents who advised that the beverage server offers them coffee/tea, juice(orange/apple/prune/cranberry), milk, and water. During the interviews residents also advised that they are allowed to have refills and are allowed 2 beverage choices along with Coffee/Tea if they choose. LPA Wesley interviewed kitchen manager Hakobyan who said the facility has a beverage server who provides beverages to the residents and they are allowed to received what ever beverage they choose including coffee, tea, and water. The investigation revealed that there is no sufficient evidence to support the allegation that staff are limiting the residents liquid consumption while in care.

Regarding allegation: Resident is being charged for services not received. LPA Wesley interviewed residents and there were 4 out of 5 residents who said they do not have any problems and said they are receiving adequate care for the services they are receiving which includes assistance with elements of daily living. Residents also stated they are comfortable with the care and services that are being provided especially when it comes to the food. Resident #2 said they are receiving great services for what they are being charged, Resident #3 stated "the staff are very good to us here!" The investigation revealed that there is no sufficient evidence to support the allegation that Resident is being charged for services not received.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. Exit interview conducted and a hard copy of the LIC 9099/LIC 9099C was provided during the exit interview.
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
LIC9099 (FAS) - (06/04)
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