197609826-8-25-2023-31-AS-NMAN-CV6VWU-20230829164827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 08/25/2023
Date Signed: 08/25/2023 11:02:52 AM

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
06/27/2022 and conducted by Evaluator LaQueena Lacy

COMPLAINT CONTROL NUMBER: 31-AS-20220627141822

FACILITY NAME:	GARDEN OF PALMS		FACILITY NUMBER:	197609826
ADMINISTRATOR:	PEARL DINKELS		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	0	CENSUS: 97	DATE:	08/25/2023
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Rena Hirsch		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Staff mistreats a resident while in care.

Staff mishandles a resident's medication while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced subsequent complaint visit to the facility on 08/25/2023 at 9:30am to deliver investigative findings. Upon arrival LPA met with Rena Hirsch and explained the purpose of this visit.

#1. Staff mistreats a resident while in care:

It is alleged that staff #1 (S1) hurt R1 and is mean and evil. To investigate the above allegation, LPA conducted interviews with staff on 07/07/2022 at 11:31am. additional interviewes were conducted with staff and residents were interviewed on 10/13/2022 at approximately 12:10pm. Interviews with five (05) out of (05) residents determined they have not witnessed S1 mistreat or hit any residents and they are nice and helpful. Interviews with staff confirmed they have not been told by R1 or any residents that S1 hurt them or is mean and evil.
Continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

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-20220627141822

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: 08/25/2023

NARRATIVE

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At the time of the investigation while conducting record review of R1 physicians report that states they have confusional arousal, and occasionally confused/disoriented. Based on interviews, observations, and record review there is not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time.

#2. Staff mishandles a resident's medication while in care:

It is alleged that it takes 4 hours before R1 receives pain medication, and staff will not mention to R1 what the medications are for and who prescribed them. To investigate the above allegation, interviews with five (05) out of (05) residents confirm they receive their medication on time and staff is good with reminding them to take their medications. They have not had any issues receiving their medications on time. During interviews with staff, they revealed R1 is taken to the medication room and shown all medications that they are prescribed, and staff will lookup medication in order to show R1 what the medications they are taking and R1 has a Pro Re Nata (PRN) for pain, and they had not requested the PRN. Upon record review of R1s physicians report states they have mild cognitive impairment and their Medication Administration Record, they have one (01) pain medication that is a PRN and it had not been administered. Based on interviews, observations, and record review there is not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards are noted during this visit.

No deficiencies cited, exit interview conducted, copy of report and appeal rights issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

LIC9099 (FAS) - (06/04)

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