197609826-5-25-2023-31-AS-NGID-CV7KXK-20230830081738

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 05/25/2023
Date Signed: 05/25/2023 08:03:59 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
05/23/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230523163750

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: 78	DATE:	05/25/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Nijara Acharya, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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At 10:00am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with the Administrator and explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 10:00 AM, LPA met with the Administrator and requested resident and staff roster. At approximately 10:05 AM, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. At 10:15 AM, LPA requested copies of pertinent information which include, but not limited to Physician’s report, Appraisal Needs and Services Plan, Resident Appraisal and Staff training, etc., relevant to the investigation. Between 10:35 AM – 11:30 AM, LPA interviewed the Administrator, Welness Director, three (3) staff members and eight (8) residents. LPA also spoke with other witnesses involved in R1’s care and supervision, at 11:35 AM.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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-20230523163750

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: 05/25/2023

NARRATIVE

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LPA interviewed eight (8) residents and seven (7) out of eight (8) residents denied the allegation and reported staff never handled them in a rough manner. LPA interviewed three (3) staff and a witness, involved in R1's care and supervision and all denied the allegation and reported no resident ever complained staff
handled them roughly and also they never seen any staff handled resident in a rough manner. In addition, Wellness Director reported that staff received training on how to handle residents and all residents are being treated with care. Based on inspection, observation and interviews there is no sufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated at this time.

No deficiency issued during today's visit.
Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC9099 (FAS) - (06/04)

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