197609826-3-30-2023-31-AS-MVAO-CRHS39-20230504133044

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609826
Report Date: 03/30/2023
Date Signed: 03/30/2023 03:27:38 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
03/28/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230328150138

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:	03/30/2023
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Nirjara Acharya, Executive Director		TIME COMPLETED:	03:27 PM

ALLEGATION(S):

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Staff are not following infection control practices
Staff do not have planned activities for the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility. LPA arrived at 09:30 AM. Upon entry, LPA met with the Executive Director, Nirjara Acharya, and explained the reason for the visit.

--- Staff are not following infection control practices.

It was alleged that facility may not be adequately separating COVID 19 positive residents from remainder of resident population. To investigate the allegation, on 03/30/2023 at 10:00 AM, LPA conducted a physical plant tour, at 11:00 AM, requested documents, from 11:15 AM – 12:30 PM, interviewed five (05) staff, and from 12:45 PM – 1:45 PM, interviewed six (06) residents.

(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: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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-20230328150138

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: 03/30/2023

NARRATIVE

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During a physical plant tour, LPA observed that residents who tested positive for COVID 19 have signs posted on their doors and postage to identify red zones, there are PPE storage units outside of each room containing, gloves, masks, sanitizers and donning and doffing equipment. LPA also observed that COVID 19 positive residents are quarantined together. Record review shows that COVID 19 positive residents are either in a single unit or share a room with other COVID 19 positive residents. During interviews with staff, they all stated that COVID 19 positive residents are not sharing the same living space as the COVID 19 negative residents and that the moment a resident is identified as positive, the negative residents are relocated to another rooms.
Based on observations, record review and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff do not have planned activities for the residents.

It was alleged that residents remain in their rooms uncovered, that there is a lack of socialization effort and facility does not play music for engagement. To investigate the allegation, on 03/30/2023 at 10:00 AM, LPA conducted a physical plant tour, from 11:15 AM – 12:30 PM, interviewed five (05) staff, and from 12:45 PM – 1:45 PM, interviewed six (06) residents. During a physical plant tour, LPA observed activities calendars in both Assisted Living and Memory Care. LPA observed residents in both Memory Care and Assisted Living participating in activities, socializing and listening to music. LPA observed that all residents were dressed and covered appropriately. During interviews with staff, they all stated that residents have activities every day, that there are plenty of activities available and residents are encouraged but not forced to participate in activities. Staff also stated that music is either played live or over the radio and that they try to identify preferred activities to keep them out of their rooms and engaged with other residents whenever possible. During interviews with residents, Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), Resident #5 (R5) and Resident #6 (R6) all stated that there are enough activities, they are not forced to stay in their rooms, music is played often, and resident are dressed and covered appropriately. LPA was unable to interview Resident #1 (R1) who was asleep and under hospice care.
Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.
Exit interview was 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: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC9099 (FAS) - (06/04)

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