197609826-3-21-2023-31-AS-NMAN-CRASDY-20230427134756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 03/21/2023
Date Signed: 03/21/2023 12:27:49 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
01/20/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230120164320

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:	130	CENSUS: 64	DATE:	03/21/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nirjara Acharya, Executive Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility threatened resident with an eviction.

INVESTIGATION FINDINGS:

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This is an addendum of the licensing report previously completed on 01/26/2023.
Upon further review of all available information and documents, it was concluded that the final finding should be changed. Therefore, LPA Abeye Duguma visited the facility to deliver corrected copy of the report. The purpose of this visit was explained to the Executive Director.

On 01/26/2023 at 10:45am Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced initial 10day complaint visit to the facility to investigate the above allegation. Upon arrival LPA Lacy met with Matan Burstyn and explained the purpose of this visit.

It is alleged that the facility is threatening to evict a conserved resident due to nonpayment of rent.
To investigate the above allegation, on 01/26/2023 LPA conducted a physical plant tour at 10:52am. LPA requested copies of document relevant to the investigation at approximately 11:38am.
(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: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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-20230120164320

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: 03/21/2023

NARRATIVE

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LPA conducted interviews with staff at 11:20am. Staff revealed that they did not issue any eviction notices to conserved resident. Staff also indicated that they have no knowledge about any conserved resident residing in the facility. During initial investigation staff provided a fax from 12/21/2022 with a confirmation page attached to eviction notices submitted to the department.

Based on interviews, observations, and record review there is no sufficient information and/or evidence to conclude that facility threatened to evict conserved resident. Therefore, the allegation is Unsubstantiated at this time.

Exit interview was conducted, and a copy of 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: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC9099 (FAS) - (06/04)

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