197609342-8-7-2023-31-AS-NMAN-CXCP34-20231107095652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609342
Report Date: 08/07/2023
Date Signed: 08/07/2023 04:22:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/02/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230802151658

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: 99	DATE:	08/07/2023
		UNANNOUNCED	TIME BEGAN:	10:04 AM
MET WITH:	Nonna Shapiro		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff member slapped resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegation. LPA met with the Administrator, Nonna Shapiro, and explained the reason for the visit.

--- Staff member slapped resident in care.
It was alleged that a staff member slapped Resident #1 (R1) in the face. To investigate the allegation, on 08/07/2023 at 11:00 AM, LPA interviewed five (05) staff, ten (10) residents and other parties. All staff and residents stated they have never experienced, witnessed, or heard about any staff abusing residents. During interviews with other parties, they stated R1 reported being hit by a staff member, but that R1 does not recall who the staff member is. LPA was unable to interview R1 as they are no longer receiving treatment at last known location and the telephone number provided is not a working number.
Based on interviews, there is not enough information to verify the allegation, therefore, the allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

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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