197609342-6-29-2022-28-AS-RORN-CHTU77-20220831151928

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609342
Report Date: 06/29/2022
Date Signed: 06/29/2022 03:52:41 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, 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
06/22/2022 and conducted by Evaluator Nune Margaryan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220622140347

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:	06/29/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Receptionist Munoz Mercedes and Business Office Manager Krystie Kim		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility has bed bugs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation due to the above allegation. LPA Nune Margaryan met with Business Office Manager Krystie Kim and explained the reason for the visit. Administrator Nonna Shapiro arrived at one hour later.

The investigation consisted of the following: LPA Nune Margaryan obtained a copy of the staff roster, residents roster, SIR dated 06/21/22 for hospitalization of Resident #1 (R1), Pest Control Company service contract and invoices for the past 3 months. LPA toured the facility and inspected randomly chosen 10 rooms. Interviews were held with the Business Office Manager, Administrator, 4 Staff, and 10 Residents. LPA also interviewed Pest Control representative who was treating the facility as a precaution.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

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-20220622140347

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: 06/29/2022

NARRATIVE

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The investigation revealed the following: Regarding allegation: Facility has bed bugs. It was reported that on 6/21/22 while transporting the resident (R1) to the hospital paramedics observed bed bugs on the resident.

During facility's tour LPA observed 10 residents rooms Including R1's room. All rooms were clean. Each bed, bedding, and mattresses were clean and no bed bugs were observed.

During interviews with residents, all residents stated to not observed or have bed bugs in their room. interviewed staff stated that have not observed bed bugs in resident's rooms or facility. Administrator and Office Manager stated that the facility treated by a pest control company 3 times a month. Office Manager provided copies of contract and invoices for services.. At the time of visit Pest Control company representative was at the facility and was interviewed by LPA. He stated that they have a contract with the facility and treating the facility 3 times a month as a precaution. LPA did not observe any bed bugs on the client's clothing during the interviews.

Although the allegation 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 allegation is Unsubstantiated.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

LIC9099 (FAS) - (06/04)

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