197609826-10-3-2023-31-AS-NMAN-CWKUHE-20231013153550

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 10/03/2023
Date Signed: 10/03/2023 02:29:59 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.ASC, 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
05/02/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230502162301

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:	0	CENSUS: 98	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	12:32 PM
MET WITH:	Rena Hirsch - Executive Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff leave resident in soiled diapers due to a lack of staffing

Due to a lack of supervision, resident has frequent falls

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit at this facility to deliver the findings for the above allegations. LPA met with Executive Director Rena Hirsch and explained the reason for the visit.

It was reported that Resident #1 (R1) is often left in soiled diapers as there is not enough staff to change the resident. Investigation of the allegation was imitated by LPA La Queena lacy on 05/11/23. During the initial visit LPA Lacy interviewed staff at 12:40pm and residents at 2:25pm. During this visit LPA Alvizar also spoke with additional staff and interviewed 10% of residents receiving incontinent care. Staff denied neglecting R1’s incontinent care. Interviews revealed that R1 is taking medications resulting frequent bladder and bowel movement. Therefore, R1 was checked more frequently. Other residents interviewed during investigation had no concerns regarding their incontinent care. Based on inspection, observation and interviews, there is no sufficient information to support the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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-20230502162301

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: GARDEN OF PALMS	FACILITY NUMBER: 197609826
	VISIT DATE: 10/03/2023

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that due to a lack of supervision, resident has frequent falls. It was reported that the resident has had multiple falls due to not being supervised. Investigation of the allegation was imitated by LPA La Queena Lacy on 05/11/23. During the initial visit LPA Lacy LPA interviewed staff at 12:40 PM and residents at 2:25 PM

In addition, prior to this visit on 09/06/23 at 10:30 AM and 09/27/23 at 9:45 AM, LPM Margaryan spoke with Executive Director and Staff #1 (S1). Interviews revealed that R1 has a wandering behavior. R1 does not stay on own room and pacing the hallways, common areas and mostly goes to TV room. While R1 is in the TV room. Staff is providing standby supervision. R1 likes to sleep in the TV room. When R1 tries to stand up and walk, R1 fell forward due to unsteady gait. Most of the time staff can reach and prevent the fall. There are times, however that R1 gets up so quickly that staff was unable to reach R1 to prevent or break the fall. A review of facility records conducted on 09/05/23 verifies the information revealed from interview with staff.

The information revealed from interviews and record review revealed that there is insufficient information to conclude that R1 has frequent falls due to lack of supervision. Therefore, the allegation deemed UNSUBSTANTIATED at this time.

No citations were issued during this visit.

Exit interview conducted and a copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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