197609826-10-6-2022-31-AS-NMAN-CL9U4X-20221117141551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 10/06/2022
Date Signed: 10/06/2022 02:13:37 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
10/05/2022 and conducted by Evaluator LaQueena Lacy

COMPLAINT CONTROL NUMBER: 31-AS-20221005120556

FACILITY NAME:	GARDEN OF PALMS		FACILITY NUMBER:	197609826
ADMINISTRATOR:	MENACHEM GINSBURG		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	130	CENSUS: 47	DATE:	10/06/2022
		UNANNOUNCED	TIME BEGAN:	10:59 AM
MET WITH:	Menachem Ginsburg		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Illegal eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced 10 day initial complaint visit to the facility on 10/06/2022 at 10:49am to investigate the above allegations. Upon arrival LPA Lacy met with staff Rena Hirsch and explained the purpose of this visit.

LPA conducted a physical plant tour at 10:56am.

It is alleged that resident #1 (R1) is not being accepted by the facility following a discharge from the hospital. To investigate the above allegation LPA interviewed Administrator and staff at approximately 11:19am. Interviews with administrator and staff revealed they did not evict R1 or refused accepting R1 back to the facility, but requested R1 be reevaluated for additional health issues. Staff #3 confirmed with hospital case manager that R1 was not ready for discharge due to additional treatment being received and will inform S3 of R1 status and discharge date when determined. LPA requested documents relevant to the investigation at approximately
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

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-20221005120556

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: 10/06/2022

NARRATIVE

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11:46am. LPA observed R1s bedroom at 1:47pm to be neat and free from obstruction. R1s belongings are present in the dresser drawers and clothing hanging in the closet. LPA did not observe any packing material or items being prepared for moving. Based on interviews and observations, there is not enough corroborating evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

No deficiencies cited, exit interview conducted, copy of report and appeal rights issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC9099 (FAS) - (06/04)

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