197609826-9-26-2023-31-AS-RRAZ-CWPSRX-20231017140702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 09/26/2023
Date Signed: 09/26/2023 02:46:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
06/09/2023 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20230609145417

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: 99	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Rena Hrich		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are not according resident with comfortable living accommodation.
Staff do not manage residents' behaviors.
Staff did not distribute resident's medication as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Evelin Rios, Michael Cava conducted an unannounced subsequent complaint visit to the facility to investigate the above allegations. LPAs met with the Executive Director, Rena Hirsch, and explained the reason for the visit.

Allegation #1: Staff are not according resident with comfortable living accommodation.

It was alleged that Resident #2 (R2) defecates on the bathroom floor and in plastic bags and staff do not address the problem. To investigate the allegation on 09/26/2023 at approximately 11:37 a.m., LPA interviewed R2. During interview with R2, R2 stated that they did have an accident one time due to a diet change. According to R2, staff assisted with incontinent care and cleaning the bedroom. Interview with staff #2 corroborates caregivers are assigned to residents who require incontinent care and assistance to the bathroom and housekeeping will clean rooms once a day or as needed.
(LIC 9099-C Continued on next page)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20230609145417

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDEN OF PALMS	FACILITY NUMBER: 197609826
	VISIT DATE: 09/26/2023

NARRATIVE

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Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time

Allegation #2: Staff do not manage residents' behaviors.

It was alleged that R2 would cough loudly and make noise all night long and staff did not address the problem. To investigate the allegation on 09/26/2023 at approximately 11:37 a.m., LPA interviewed R2, R2 stated they sleep well at night and if they have trouble sleeping they will walk the halls to help. R2 denies the allegation and according to R2 they haven't coughed more then usual. LPA interview with Executive Director revealed they received notification from Resident #1 (R1) that R1 wanted R2 moved out of the room. At the time R2 could not be moved due to no available room. According to the Executive Director R2's family member also requested R2 be transferred out due to the treatment R2 was receiving from R1. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Allegation #3: Staff did not distribute resident's medication as prescribed.

It was alleged that R1 was not provided their medication for five days. To investigate the allegation on 09/26/2023 at approximately 11:47 a.m. LPA interviewed staff #1 (S1), according to S1, R1 can manage and store their own medication. LPA reviewed R1's Physician's Report that corroborate R1 can store and manage their own medication. LPA interview with R1, R1 confirms they did not receive their medication for five days when they first arrived to the facility. Interview with the Executive Director at approximately 2:00 p.m. denied the allegation. Interview with Executive Director and S1 revealed R1 has refused to take medication. LPA reviewed progress notes that reported R1's medication refusals. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

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

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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