197609342-4-3-2024-31-AS-NMAN-D5GUZF-20240521160127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609342
Report Date: 04/03/2024
Date Signed: 04/03/2024 04:01:29 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
10/19/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20231019120206

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: 112	DATE:	04/03/2024
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Nonna Shapiro		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff neglected a resident in care leading to resident developing stage 3 pressure injuries.
Staff did not feed a resident in care leading to resident becoming malnourished.
Staff did not prevent resident from developing an infection while in care.
Resident sustained unexplained injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. At around 10:00 AM LPA met with the Administrator, Nonna Shapiro, and explained the reason for the visit.

--- Staff neglected a resident in care leading to resident developing stage 3 pressure injuries.

It was alleged that Resident #1 (R1) developed stage three injuries while in the facility. To investigate the allegation on 10/23/2023 LPA requested pertinent documents at 12:30 PM and interviewed staff and other parties between 1:00 PM to 03:30 PM. On 04/03/2024, LPA interviewed a third party at 3:00 PM. A review of Physician’s Reports, Home Health records and hospital discharge documents did not indicate that resident had stage three (03) or any other pressure injuries. During interviews with staff, all staff stated that the resident did not have pressure injuries while in the facility.
(CONT on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 31-AS-20231019120206

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOS FELIZ GARDENS	FACILITY NUMBER: 197609342
	VISIT DATE: 04/03/2024

NARRATIVE

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During interviews with other parties, they stated R1 developed pressure at a different facility after moving out of this facility. During interview with third party, they stated that resident did not develop pressure injuries in the facility.

Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff did not feed a resident in care leading to resident becoming malnourished.

It was alleged that facility was not feeding the resident which led to malnourishment. To investigate the allegation on 10/23/2023 LPA requested pertinent documents at 12:30 PM and interviewed staff between 1:00 PM – 3:30 PM. On 04/03/2024, LPA interviewed ten (10) residents from 1:00 PM to 3:00 PM and a third party at around 3:00 PM. A review of Physician’s Reports, Home Health records and hospital discharge documents did not indicate that resident was malnourished. A review of the facility’s menu revealed that facility offers well-balanced nutritious meals throughout the day with various options. During interviews with staff, all staff stated they not only fed the resident and provided the same meals as everyone else but purchased additional food according to R1’s preference using staffs’ own money. Staff added, resident had a very healthy appetite while in the facility. During interviews with residents, all residents stated they are served three (03) meals a day and that snacks are available throughout the day. During interview with third party, they stated that R1 loved to eat and did not suspect any malnourishment or inconsistencies in weight while in the facility.

Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff did not prevent resident from developing an infection while in care.

It was alleged that Resident #1 (R1) developed infection while in the facility. To investigate the allegation on 10/23/2023 LPA requested pertinent documents at 12:30 PM and interviewed staff between 1:00 PM to 03:30 PM. On 04/03/2024, LPA interviewed a third party at around 3:00 PM.
(CONT on LIC 9099-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20231019120206

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOS FELIZ GARDENS	FACILITY NUMBER: 197609342
	VISIT DATE: 04/03/2024

NARRATIVE

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A review of Physician’s Reports, Home Health records and hospital discharge documents did not indicate that resident had an infection. During interviews with staff, all staff stated that there were no signs of infection upon admittance and that R1 was sent to the hospital when signs were first noticed by physician and that R1 did not return to the facility after hospitalization. During interviews with third party, they stated that R1 was sent to the hospital as soon as the redness around the knee was first discovered and that they are not aware of any injury sustained in the facility that may have caused it and that it may have been cause by hardware in the knee combined with preexisting conditions.

Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Resident sustained unexplained injuries while in care.

It was alleged that R1 had unexplained sores on the palms of their hand. To investigate the allegation on 10/23/2023 LPA requested pertinent documents at 12:30 PM and interviewed staff between 1:00 PM to 03:30 PM. On 04/03/2024, LPA interviewed a third party at around 3:00 PM. A review of Physician’s Reports, Home Health records and hospital discharge documents did not indicate that R1 had sores on their palms. During interviews with staff and third party, they stated that are not aware of any sores during their stay in the facility.

Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

LIC9099 (FAS) - (06/04)

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