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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 11/25/2024
Date Signed: 11/25/2024 02:27:45 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
05/25/2023 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230525084255
FACILITY NAME:GARDEN OF PALMSFACILITY NUMBER:
197609826
ADMINISTRATOR:GINSBURG, MENACHEMFACILITY TYPE:
740
ADDRESS:1025 N FAIRFAX AVETELEPHONE:
(323) 656-7900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:0CENSUS: 109DATE:
11/25/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Adam SyncheffTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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1. Staff do not meet resident's incontinence needs
2. Staff confine residents' to their bedrooms
3. Staff do not provide residents with toiletries
4. Staff do not provide residents with linen
5. Staff do not provide residents with housekeeping services
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness and Licensing Program Manager (LPM) Troy Agard conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. LPA and LPM met with Adminstrator Adam Syncheff and informed him the reason of the visit. The inital visit was conducted by (LPA) Angela Panushkina on 05/25/2023. During today's visit, from 945am to 245pm, LPA and LPM, conducted interviews, reviewed facility and resident documents, and physical plant inspection. The following was determined:

Regarding the allegation #1: Staff do not meet resident's incontinence needs. It’s being alleged residents have to wait more than two hours to have their diaper changed. R1-R2 were unavailable for an interview. During interviews with staff, it was determined that residents are checked as often as every 1-2 hours. According to S2, caregivers are required to write their initial and a timestamp on the diaper of each resident after they are changed. During interviews with residents, including those with incontinent needs, they confirmed staff assist them with changing their diaper and do not have to wait long periods of time. Based on record review, and
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
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 5
Control Number 31-AS-20230525084255
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: 11/25/2024
NARRATIVE
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resident and staff interviews the allegation is Unsubstantiated.

Regarding the allegation # 2: Staff confine residents to their bedrooms. It’s being alleged staff lock residents who have dementia inside of their bedrooms. R1-R2 were unavailable for an interview. During interviews with staff, it was determined that residents are encouraged to leave their room during wake hours and are not locked in their room. LPA & LPM observed the memory care unit to be secured but not having locks that would allow for residents to be locked in their room by staff. During interviews with residents, they all confirmed no staff lock them or confine them to their room. Based on observation and resident and staff interviews the allegation is Unsubstantiated.
Regarding the allegation # 3: Staff do not provide residents with toiletries. It’s being alleged that the facility is not providing toiletries such as toilet paper. R1-R2 were unavailable for an interview. During interviews with staff, it was determined that residents have access to a variety of toiletries upon request including toilet paper which is provided by housekeeping daily. During a physical plant tour, LPA and LPM both observed a sufficient supply of personal hygiene items. During interviews with residents, they confirm having access to the toiletries provided by the facility but often prefer to purchase their own. Based on observation and resident and staff interviews the allegation is Unsubstantiated.

Regarding the allegation # 4: Staff do not provide residents with linen. It’s being alleged that the facility staff do not provide bed linen for their bed, nor towels. R1-R2 were unavailable for an interview. During interviews with staff, it was determined that residents are provided with linen such as bed sheets, blankets, towels, etc from housekeeping. Bedding is changed once per week and extra towels are available upon request. Residents are able to purchase their own sheets if they desire but the facility provides, should they need. During a physical plant tour, LPA and LPM observed an overstock of linen in some of the bedrooms. LPM also observed several boxes of unopen linen available for use. During interviews with residents, they state sheets are changed on a weekly basis. Based on observation and resident and staff interviews the allegation is Unsubstantiated.

Regarding the allegation # 5: Staff do not provide residents with housekeeping services. It’s being alleged that staff do not clean, sanitize resident’s bedroom, floors, bathroom, or toilet. R1-R2 were unavailable for an interview. During interviews with staff, it was determined that housekeeping is onsite every day and provides services to all residents. Deep cleaning is completed once a week, which is defined by cleaning and sanitizing the bathroom, dusting, sweeping and mopping the entire unit.

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/25/2023 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230525084255

FACILITY NAME:GARDEN OF PALMSFACILITY NUMBER:
197609826
ADMINISTRATOR:GINSBURG, MENACHEMFACILITY TYPE:
740
ADDRESS:1025 N FAIRFAX AVETELEPHONE:
(323) 656-7900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:0CENSUS: 109DATE:
11/25/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Adam SyncheffTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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2
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8
9
Facility has pests
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness and Licensing Program Manager (LPM) Troy Agard conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. LPA and LPM met with Adminstrator Adam Syncheff and informed him the reason of the visit. The inital visit was conducted by (LPA) Angela Panushkina on 05/25/2023. During today's visit, from 945am to 230pm, LPA and LPM, conducted interviews, reviewed facility and resident documents, and physical plant inspection. The following was determined:
Regarding the allegation: Facility has pests. It’s being alleged facility has bed bugs. R1-R2 were unavailable for an interview. During interviews with staff, it was determined in January 2024 the facility was treated for bed bugs. LPA & LPM reviewed documentation of services provided to address bed bugs found in several rooms. During interviews with staff, it was also confirmed that bedbugs were found, and the facility was treated upon discovery. Based on record review, and staff interviews the allegation is Substantiated. POC is cleared during visit, by the facility providing documentation of pest control services. Exit interview, appeal rights, copy of report provided to Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20230525084255
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2024
Section Cited
CCR
87303(a)
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Maintenance and Operation: (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met, evidenced by:
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Administrator provided copies of Orkin pest control services that provide monthly pest services for the facility. Therefore, the POC is cleared.
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During today's complaint visit, it was confirmed by the Administrator that the facility did have a bed bug issue, but they were able to eradict them, by having a monthly treatment service. This poses as a potential health and safety risk to residents in care.
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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: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20230525084255
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: 11/25/2024
NARRATIVE
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In the event a resident has an accident, housekeeping works tandem with the caregivers in cleaning the area(s) impacted. During interviews with residents, they confirm housekeeping comes once a week for a deep cleaning. Based on staff and resident interviews the allegation is Unsubstantiated.

Exit interview and copy of report provided to Administrator.

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5