197609826-11-29-2023-31-AS-NMAN-CY9QB7-20231206110106

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 11/29/2023
Date Signed: 11/29/2023 03:24:55 PM

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
08/11/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230811083256

FACILITY NAME:	GARDEN OF PALMS		FACILITY NUMBER:	197609826
ADMINISTRATOR:	RENA HIRSCH		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	0	CENSUS: 94	DATE:	11/29/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Rena Hirsch		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not seek emergency medical services for resident.

INVESTIGATION FINDINGS:

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This is the addendum of the licensing report previously issued on 08/28/2023. The report was amended to make a correction.
Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with the Executive Director, Rena Hirsch, and explained the reason for the visit.
--- Staff did not seek emergency medical services for resident.
It was alleged that the Resident #2 (R2) was asked by staff to contact 911 for a roommate that required emergency services. To investigate the allegation on 08/14/2023 at around 2:30 PM, LPA interviewed R2 and two staff. During interviews R2 stated that they did not call 911. During interviews with staff, all staff stated that they did not instruct R2 to call 911 and that staff are the ones that contacted emergency services. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
(CONT. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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 6

Control Number 31-AS-20230811083256

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: 11/29/2023

NARRATIVE

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--- Staff did not respond to resident's calls for assistance in a timely manner.

It was alleged that staff would not answer resident’s call for assistance. To investigate the allegation on 08/14/2023 at around 2:30 PM, LPA interviewed residents and staff, on 08/18/2023 at around 10:30 AM LPA, made observations during a physical plant tour and at around 11:00 AM and LPA interviewed additional staff and residents at around 12:30 PM. During interviews with residents, two out of nine residents stated that staff take up to an hour to respond to calls and push buttons and the remaining seven out of nine residents stated that staff respond to calls and push buttons within a reasonable time not exceeding 20 minutes. During the physical plant tour, LPA tested staff’s response time to the call button and observed that staff responded within 10 minutes.

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

--- Licensee did not ensure facility ceilings are in good repair.

It was alleged that a piece of wood fell from the ceiling and hit Resident #1’s (R1) foot. To investigate the allegation on 08/14/2023 at around 1:30 PM, LPA conducted physical plant tour and at around 2:30 PM interviewed staff and residents. On 08/18/2023 at around 11:00 AM, LPA interviewed additional staff and residents at around 12:30 PM. During the physical plant tour, LPA observed that the ceiling is not composed of any wood or wood-like material. The ceiling is all white, flat, and free from any damage or discoloration. During interviews with residents, R1 stated that it was not from the ceiling and that a piece of wood that belonged to R1 was propped up against the wall, fell over and hit R1’s foot. R1 stated that they requested for rubbing alcohol in a bottle but that they facility only had rubbing alcohol in wipe form. All other residents and staff stated that they are not aware of any wood or wood-like material falling from ceilings.

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

(CONT. on LIC 9099-C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 31-AS-20230811083256

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: 11/29/2023

NARRATIVE

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--- Facility staff are not practicing proper food handling.

It was alleged that cook uses hands to take out margarine to make eggs and other foods and servers wearing gloves are touching objects, then touch food without changing gloves. To investigate the allegation on 08/14/2023 at around 1:30 PM, LPA conducted a physical plant tour, at 2:30 PM interviewed staff and residents and on 08/18/2023 at around 11:00 AM, LPA interviewed additional staff and residents at around 12:30 PM. During the physical plant tour, LPA observed culinary director and cook wearing gloves and using utensils to use ingredients and observed cooks plating the food and the serving staff picking up plated food to serve it to residents. During interviews with staff, all staff stated that the cooks always use utensils and have never used their hands to take out margarine or other ingredients and that servers do not handle food. During interviews with residents, R1 stated they saw the cooks using their hands to take out margarine to make eggs. All other residents stated they have never seen staff using their hands to take out ingredients or any other unsanitary cooking methods.

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

--- Facility staff are not keeping facility kitchen clean.
It was alleged that R1 was served milk for cereal in a dirty mug that had coffee in it. To investigate the allegation on 08/14/2023 at around 1:30 PM, LPA conducted a physical plant tour, at 2:30 PM interviewed staff and residents and on 08/18/2023 at around 11:00 AM, LPA interviewed additional staff and residents at around 12:30 PM. During the physical plant tour, LPA observed easily accessible clean cups and mugs located on a rack near the dining room exit and dishwashers cleaning used ware. During interviews with residents, R1 stated that they were given liquids in an already used mug. All other residents and all staff stated that they have never experienced or witnessed anyone being served food or liquids on dirty kitchen ware.

Based on interviews and observations, 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: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 6

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
08/11/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230811083256

FACILITY NAME:	GARDEN OF PALMS		FACILITY NUMBER:	197609826
ADMINISTRATOR:	RENA HIRSCH		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	0	CENSUS: 94	DATE:	11/29/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Rena Hirsch		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff are not preventing other residents from disturbing the resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with the Executive Director, Rena Hirsch, and explained the reason for the visit.

--- Facility staff are not preventing other residents from disturbing the resident.

It was alleged that a resident across the hall is yelling at all hours of the night. To investigate the allegation on 08/14/2023 at around 2:30 PM interviewed staff and residents and on 08/18/2023 at around 11:00 AM, LPA interviewed additional staff and residents at around 12:30 PM. On 11/29/2023, LPA made observations during a physical plant tour at around 10:30 AM. During interviews with staff, all staff stated that resident across the hall from R1 sometimes yells because resident wants things that they cannot find in their room and that all staff have repeatedly instructed resident to use the call button. During interviews with residents, R1 stated that resident across the hall yells in the middle of the night and it is very disturbing.
(CONT. on LIC9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 31-AS-20230811083256

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: 11/29/2023

NARRATIVE

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All other residents stated that they hear loud voices but do not know exactly where it is coming from. During the physical plant tour, LPA observed that R1's room is roughly fifty (50) feet from the nearest staff office.

Based on interviews and observations, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No health and safety hazards noted during the visit.

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

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 31-AS-20230811083256

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/29/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/04/2023 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:..(2)To be accorded safe, healthful and comfortable accommodations... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87468.1 Personal Rights of Residents; The written letter must be sent to the LPA by the POC due date.
	8 9 10 11 12 13 14	Based on interviews, R1 is loud when calling out for help which disrupts the comfort and health of others which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

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