197609826-5-24-2021-31-AS-MVAO-C4GMKQ-20210630094106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 05/24/2021
Date Signed: 05/24/2021 10:10:29 AM

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
12/10/2020 and conducted by Evaluator Naira Margaryan

COMPLAINT CONTROL NUMBER: 31-AS-20201210115619

FACILITY NAME:	GARDEN OF PALMS		FACILITY NUMBER:	197609826
ADMINISTRATOR:	COHEN, YEHUDAH		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	130	CENSUS: 32	DATE:	05/24/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Yonatan Izaacs		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Facility did not release resident's medical records upon request.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Naira Margaryan conducted unanounced complaint visit to the facility. LPA met the Executive Director (ED) and explained the purpose of this visit.

It was reported that the facility did not provide copies of the resident #1 (R1’s) records to the legal representative of the R1’s responsible party.

To investigate this allegation, on 12/15/20 at 8:30am, LPA Margaryan spoke with the Executive Director (ED) and on 3:30pm, LPA spoke with other staff.
Interviews revealed that the facility staff never refused to submit required records. Different individuals were calling the facility as "Legal representative(s)" of R1's responsible party. They were requesting records over the phone and/or via fax without providing written consent signed by R1’s representative to verify that the records are requested on their behalf. ED stated that requested documents were submitted on 12/15/2020, after receiving clarifying information from the legal advisor, representing R1’s responsible party.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Naira Margaryan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

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 31-AS-20201210115619

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: GARDEN OF PALMS	FACILITY NUMBER: 197609826
	VISIT DATE: 05/24/2021

NARRATIVE

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A review of facility records conduced on 05/21/2021 at 5:30pm, verified the information revealed from interviews.
Based on interviews and record review, there is no supporting information to verify the allegation. Therefore, the allegation is unsubstantiated at this time.

No immediate health and safety hazard is noted during this visit.
Exit interview was conducted and a copy of report was issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Naira Margaryan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC9099 (FAS) - (06/04)

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