197609826-9-20-2023-31-AS-NMAN-CW2V43-20230926160539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 09/20/2023
Date Signed: 09/20/2023 04:16:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
12/01/2022 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20221201163731

FACILITY NAME:	GARDEN OF PALMS		FACILITY NUMBER:	197609826
ADMINISTRATOR:	MENACHEM GINSBURG		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	0	CENSUS: 98	DATE:	09/20/2023
		UNANNOUNCED	TIME BEGAN:	10:38 AM
MET WITH:	Rena Hirsch, Executive Director		TIME COMPLETED:	01:33 PM

ALLEGATION(S):

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Facility staff evicted resident for wandering away from facility.

Facility staff did not safeguard resident’s belongings.

Facility staff does not abide by facility contract.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced subseqent visit to deliver the findings for the above noted allgegation.. LPA met with Executive Director Rena Hirsch and explained the reason for the visit.

It was reported that facility staff evicted a resident for wandering away from the facility. To investigate this allegation on 12/06/2022 between 2:00pm and 2:30pm, staff interviews were initiated. Interviews revealed that Resident #1 (R1) was not evicted from the facility, but rather was transfered to another community. The reason that R1 was transfered to another assisted living was because they were considered a wandering risk and a danger to themselves. R1 was physically able to jump over the security parameters of the community and was not worried about getting lost. According to staff, R1's responsible party was notified of the issue and they agreed to have R1 transfered to another community. On 9/20/2023, between 11:00am and 12:00pm, facility records were reviewed. Records confirmed what staff told LPA. R1 had wandering behaviors.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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-20221201163731

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDEN OF PALMS	FACILITY NUMBER: 197609826
	VISIT DATE: 09/20/2023

NARRATIVE

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Based on interviews and records review, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

It was alleged that facility staff did not safeguard resident's belongings which consisted of a land-line phone, bath towels, and $69 dollars. To investigate this allegation on 12/06/2022 between 2:00pm and 2:30pm, staff interviews were initiated. Interviews revealed that R1's family came to the facility to pack and pick up R1's belongings. On 9/20/2023, between 11:00am and 12:00pm, facility records were reviewed. Records revealed that per R1's inventory list, they only had legal documents and cash which they carried with them. The inventory list did not list any other personal belongings.

Based on interviews and records review, there is not sufficient information to support this allegation. Thus, the allegation is deemed UNSUBSTANTIATED at this time.

It was reported that facility staff does not abide by facility contract. To investigate this allegation on 12/06/2022 between 2:00pm and 2:30pm, staff interviews were initiated. Interviews revealed that R1 had an outstanding balance of $2,774 dollars in unpaid monthly fees. The facility allowed R1 to transfer out of the facility without paying the money owed. On 9/20/2023, between 11:00am and 12:00pm, facility records were reviewed. Records revealed that according to the admission agreement, following termination of the agreement the facility would pay R1 or their estate a refund equal to any amount owed minus the amount of any unpaid monthly fees or other charges owed. Since R1 had unpaid monthly fees, the facility did not have a refund to give to R1 or their estate.

Bases on interviews and records review, there is not sufficient information to support this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interviewed conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

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