197609826-3-21-2023-31-AS-NMAN-CRURYX-20230515132703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 03/21/2023
Date Signed: 03/21/2023 12:32:11 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
01/20/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230120144214

FACILITY NAME:	GARDEN OF PALMS		FACILITY NUMBER:	197609826
ADMINISTRATOR:	GINSBURG, MENACHEM		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	130	CENSUS: 64	DATE:	03/21/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nirjara Acharya, Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility illegally evicted resident.

INVESTIGATION FINDINGS:

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This is an addendum of the licensing report previously completed on 01/26/2023.
Upon further review of all available information and documents, it was concluded that the final finding should be changed. Therefore, LPA Abeye Duguma visited the facility to deliver corrected copy of the report.

On 01/26/2023, at 10:45am, Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced initial 10day complaint visit to the facility to investigate the above allegation. Upon arrival LPA Lacy met with Matan Burstyn and explained the purpose of this visit.

It is alleged that on 12/21/2022 R1 received a 30 day notice to vacate. To investigate the above allegation, on 10/26/2023 at 10:52am, LPA conducted a physical plant tour.
LPA requested copies of document relevant to the investigation at approximately 11:38am.

(Cont. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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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Control Number 31-AS-20230120144214

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: 03/21/2023

NARRATIVE

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LPA conducted interviews with staff at 11:20am, and resident at approximately 3:15pm. Staff indicated that R1 is being evicted for nonpayment of rent. R1 was notified few times that nonpayment of rent may lead to an eviction. However, R1 continued not to pay delinquent amount. R1 verified that the payments were not made due to not receiving the portion of the payments from the Social Security Administration. Documents revealed that on 12/21/2022 R1 was served with the notice of demand of payment or vacate premises within 30 days. No payment was received from R1.

During the investigation staff provided a fax from 12/21/2022 with a confirmation page attached to notices confirming that 30-day Eviction notice was sent to the Department. on 12/23/2022 at 10:39am. Staff indicated that 30-day eviction notice. Investigation revealed that nonpayment of rent is a legal reason for eviction.

Based on interviews, observations, and record review there is no sufficient information to conclude that facility is illegally evicting R1. Therefore, the allegation is Unsubstantiated at this time.

Exit interview conducted, copy of report and appeal rights issued

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC9099 (FAS) - (06/04)

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