197609342-2-25-2022-28-AS-MVAO-CCDRVW-20220310122214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609342
Report Date: 02/25/2022
Date Signed: 02/25/2022 06:41:24 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
12/20/2021 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211220150451

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: 129	DATE:	02/25/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Nonna Shapiro, Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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1. Staff does not assist residents with transportation.
2. Staff denies visitation to residents.
3. Residents do not receive adequate meals.
4. Facility does not have planned recreational activities for residents.
5. Facility is understaffed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation for the allegations listed above. LPA met with Administrator, Nonna Shapiro, and explained the purpose of the visit.

The investigation consisted of the following:
On 12/23/21, LPA Chan conducted the initial visit, which consisted of a tour of the facility, interviews, and obtaining copies of the staff roster, resident roster, food menu, and documents pertaining to Resident #1. Interviews were conducted with the Administrator, 5 Staff, and 11 Residents in total.

The investigation revealed the following:
Allegation - Staff does not assist residents with transportation. It is alleged that Resident #1 was denied transportation services to dialysis treatment, the bank, and the grocery stores.

(continue on LIC 9099)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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-20211220150451

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: 02/25/2022

NARRATIVE

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LPA interviewed the Administrator and 5 Staff who all denied this allegation. They stated that resident(s) are transported to the doctor’s appointments and other places that are requested. Transportation is arranged and facility asks that the residents give advance notice. Regarding Resident #1 missing dialysis appointment, staff stated the resident has outside transportation services through Access. When the transportation did not show up, Staff arranged Uber service to take resident to the appointment. LPA interviewed 11 residents and majority stated the facility will provide transportation if requested, while 3 indicated that they do not leave the facility.

Allegation – Staff denies visitation to residents. Per the Administrator, facility staff never denied visitation to residents even during this Coronavirus (COVID-19) pandemic. Staff understand it is residents’ personal rights to receive visitation, therefore, accommodations are made to allow visitors. Per Staff, the visitors are able to meet in the common area or outdoors. The residents interviewed did not have any issues regarding visitations. Their families or friends are able to come to the facility anytime. During the visit, LPA observed the daily symptom attestation form for visitors located in the front area and the form was filled out by visitors entering the facility.

Allegation – Residents do not receive adequate meals. LPA toured the facility and observed the menu posted on the board. The residents have other options if they do not want the main course. LPA toured the kitchen and observed adequate amount of food. LPA obtained and reviewed the copies of the weekly menu for a month and appears that the facility is serving a variety of food to residents. 10 out of 11 residents interviewed like the food servings and feel that they received adequate meals. They also stated they can get more upon request.

Allegation - Facility does not have planned recreational activities for residents. LPA observed a bulletin board with activities listed for the month. Per the Activity Director, they are having smaller groups for the activities to mitigate the spread of the Coronavirus. She holds exercises in the hallways for residents who are not able to go downstairs. She announces the activities over the intercom as well as go to their rooms to try encouraging them to join. Some of the residents stated the facility provide activities such as bingo, coloring, and movies, but they choose not to attend.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20211220150451

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: 02/25/2022

NARRATIVE

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Allegation - Facility is understaffed. The Administrator stated caregivers tend to residents right away. Residents have intercoms in their rooms to call for staff and staff do rounds to check on residents often. She does not feel the facility is understaffed at all and believes there is sufficient number of staff on each shift. None of the staff interviewed feel there is a shortage. 10 out of 11 residents feel there is adequate staffing at the facility.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with the Administrator. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC9099 (FAS) - (06/04)

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