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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 10/06/2021
Date Signed: 10/06/2021 05:14:00 PM



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
10/01/2021 and conducted by Evaluator LaQueena Lacy
COMPLAINT CONTROL NUMBER: 31-AS-20211001141018
FACILITY NAME:GARDEN OF PALMSFACILITY NUMBER:
197609826
ADMINISTRATOR:COHEN, YEHUDAHFACILITY TYPE:
740
ADDRESS:1025 N FAIRFAX AVETELEPHONE:
(323) 656-7900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:130CENSUS: 36DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Jonathan IssacsTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Resident left in soiled diapers.
Resident not being provided adequate services.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) LaQueena Lacy conducted a 10day initial complaint visit for the above allegations. LPA met with Administrator Johnny Issacs and explained the purpose of this visit. The complainant alleged that R1 was observed in a soiled diaper, room not cleaned and in the same clothing from the day before. At 10:18am LPA conducted a Physical Plant Tour and observed residents Involved in multiple activities being conducted at the facility. To investigate the above allegation at approximately 10:52am LPA reviewed facility files and obtained copies of documents pertinent to the investigation. Based on review of document obtained the facility has a Caregiver Resident List, which has all residents listed with the type of service (AM/PM Shower and 2 person assistance needed) that is provided on a daily basis and a Housekeeper/Laundry List that provides what rooms need to be cleaned and laundry to be done for the day. At approximately 11:30am LPA began conducting interviews with the Assistant Administrator, Staff and Residents including those that are incontinent. During todays visit LPA observed all rooms to be clean and clear from obstruction and all residents to be well groomed and cleaned and participating in the community events.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 586-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20211001141018
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: 10/06/2021
NARRATIVE
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Information obtained through interviews reveled residents fell that staff are taking care of their needs and assisting them when needed in a timely manner. Based on observations, record review and interviews, there is insufficient information to support the allegation. Therefore, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 586-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2