197609826-8-9-2024-31-AS-NMAN-D8HMS3-20240826095116

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 08/09/2024
Date Signed: 08/09/2024 12:08:49 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
06/20/2023 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230620084658

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: 105	DATE:	08/09/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:			TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff leave residents in soiled diapers for an extended period of time
Staff do not ensure that the facility remains free of odors
Staff leave residents unattended at night
Residents continue to have multiple falls due to a lack of supervision

INVESTIGATION FINDINGS:

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At 9:50am. Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted unannounced complaint visit to the facility to complete investigation of the above noted allegations and to deliver final report. At 10:20am. LPA met with the Wellness Assistant, Karla Garcia.

To investigate the above noted allegations, during initial visit conducted on 06/23/23, LPA requested facility records at 10:25am. Records include but not limited to Memory Care residents Roster Physician’s report, Appraisal Needs and Services Plan, Unusual Incident Reports, Incontinence Log. At approximately 11:14am, LPA conducted an inspection of physical plant including memory care unit. At 12:05pm-1:24pm, LPA Alvizar-Ettima conducted interviews with facility staff including Executive Director (ED) and Wellness Director (WD). LPA attempted to speak with the residents residing at memory care. However, they were unable to respond to LPAs questions.

Continue on LIC 9909c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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 3

Control Number 31-AS-20230620084658

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: 08/09/2024

NARRATIVE

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Staff leave residents in soiled diapers for an extended period of time.
Staff do not ensure that the facility remains free of odors.

It was alleged that the residents are not being changed and are left in spiked diapers. This causes the memory care unit to smell. ED and WD revealed that Memory Care residents are being checked at least every 2 hours and incontinent care is provided as needed. LPA spoke with the staff assisting memory care residents and they indicated that the residents are changed as needed and after changing the residents, staff updates incontinent log. The housekeepers clean the rooms more than once. Dirty diapers immediately are taken away from the residents room, so the rooms do not smell like urine.

Prior to this visit LPA Alvizar-Ettima reviewed facility records including incontinent log. The information revealed from records supported the information provide by the facility personnel. At the time of facility inspection, LPA observed resident residing in memory care, and they were clean, well groomed and no one smelled like urine. At the time of inspection LPA observed housekeepers cleaning the rooms and did not smell a urine odor.

Based on inspection, observation, interviews and record review, there is no pertinent information to support the allegation. Therefore, the allegations are deemed Unsubstantiated at this time.

Staff leave residents unattended at night.
Residents continue to have multiple falls due to a lack of supervision.

It was alleged that memory care resident #1 (R1) keeps falling at night due to lack of supervision and no staff is attending R1 at night.

Interviews revealed that night shift staff makes rounds in memory care every 2 hours or more frequently if needed. Fall risk residents are being checked more frequently. ED and WD indicated that they have no resident with R1’s name residing in memory care. R1 is residing in the assisted living and does not need assistance to retain activities of daily living.
Continue LIC 9099c

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230620084658

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: 08/09/2024

NARRATIVE

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There is one night shift caregiver that is assisting only residents residing in memory care unit. The staff is checking residents through the night as needed.

A review of facility records, including incident reports, did not reveal any information to conform that the residents in memory care had fall incidents at night due to staff neglect. During facility inspection LPA Alvizar- Ettima observed and assessed residents in their rooms and did not note any bruises or spots that could result from falls.

Based on observation, interviews and record review, it was concluded that although the allegation may have happened, there is not enough supporting evidence to determine validity of the complaint. Therefore, the allegations are Unsubstantiated at this time.

No health and safety hazard is noted during this visit.
Exit interview is conducted and copy of report was provided to Wellness Assistant

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

LIC9099 (FAS) - (06/04)

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