197610403-5-9-2024-31-AS-NMAN-D5SRHK-20240531130228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 05/09/2024
Date Signed: 05/09/2024 01:22:11 PM

Substantiated

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
02/22/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240222123534

FACILITY NAME:	GARDEN OF PALMS LA		FACILITY NUMBER:	197610403
ADMINISTRATOR:	HIRSCH,RENA		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	130	CENSUS: 109	DATE:	05/09/2024
		UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Regional Director, Nirjara Acharya		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff do not ensure that resident has a working call button

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs), Abeye Duguma, conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with Regional Director, Nirjara Acharya, and explained the reason for the visit.

--- Staff do not ensure that resident has a working call button

It was alleged that facility does not have a consistently functioning call button. To investigate the allegation, on 02/27/2024, LPA conducted a physical plant tour at around 9:30 AM, interviewed three (03) staff from 10:30 AM to 12:00 PM and interviewed eleven (11) residents from 12:00 PM – 3:00 PM. During the physical plant tour, LPA observed maintenance worker fixing and testing the call button system. During interviews with staff, all staff stated the facility was experiencing issues with the call button system for a few days but that the issue was resolved, and they are currently testing the system.
(CONT. on LIC9099-C)

Substantiated

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: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

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 6

Control Number 31-AS-20240222123534

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 LA	FACILITY NUMBER: 197610403
	VISIT DATE: 05/09/2024

NARRATIVE

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During interviews with residents, seven (07) out of eleven (11) residents stated they have experienced problems with the call button and believed that it was not working. The remaining four (04) out of eleven (11) residents stated they are unaware as they do not use the call button for assistance.

Based on interviews, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 31-AS-20240222123534

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 LA	FACILITY NUMBER: 197610403
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/09/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/09/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by; Based on interviews and observations, the residents' call buttons were not in working order which poses a potential	1 2 3 4 5 6 7	Facility was not issued a POC as the call button system was repaired, tested and observed to be in working order.
	8 9 10 11 12 13 14	health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

Page: 6 of 6

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
02/22/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240222123534

FACILITY NAME:	GARDEN OF PALMS LA		FACILITY NUMBER:	197610403
ADMINISTRATOR:	HIRSCH,RENA		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	130	CENSUS: 109	DATE:	05/09/2024
		UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Nirjara Acharya		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff do not answer resident's call button in a timely manner.
Staff are unable to communicate with residents due to a language barrier.
Staff do not assist resident with incontinence needs.
Staff do not ensure that the facility remains free of odors.
Staff do not follow resident's care plan.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs), Abeye Duguma, conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with Regional Director, Nirjara Acharya, and explained the reason for the visit.

--- Staff do not answer resident's call button in a timely manner

It was alleged that it takes staff 30 minutes or more to respond to the call button. To investigate the allegation, on 02/27/2024, LPA interviewed three (03) staff from 10:30 AM to 12:00 PM and interviewed eleven (11) residents from 12:00 PM – 3:00 PM. On 05/09/2024, LPA conducted a physical plant tour at around 11:00 AM. During the physical plant tour, LPA selected five (05) rooms at random and observed an average response time of seven (07) minutes. During interviews with staff, all staff stated that it takes them between three (03) to ten (10) minutes to respond to the call buttons.
(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: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 31-AS-20240222123534

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 LA	FACILITY NUMBER: 197610403
	VISIT DATE: 05/09/2024

NARRATIVE

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During interviews with residents, all residents stated that it takes staff between five (05) to ten (10) minutes.
Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff are unable to communicate with residents due to a language barrier

It was alleged that there are many incidents of communication issues because staff do not understand what the residents are asking for. To investigate the allegation, on 02/27/2024, LPA interviewed three (03) staff from 10:30 AM to 12:00 PM and interviewed eleven (11) residents from 12:00 PM – 3:00 PM. During interviews with staff, all staff stated they can effectively communicate with residents to meet their needs. During with residents, all residents stated they do not have issues with communication and staff are able to meet their needs.

Based on interviews, there is enough not information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff do not assist resident with incontinence needs

It was alleged that Resident #1 (R1) is not checked on every two hours and not being changed. To investigate the allegation, on 02/27/2024, LPA interviewed three (03) staff from 10:30 AM to 12:00 PM and interviewed eleven (11) residents from 12:00 PM – 3:00 PM. During interviews with staff, all staff stated they check all incontinent residents every two (02) hours or more frequently if needed. During interviews with residents, eight (08) out of eleven (11) residents stated they are checked on every two (02) hours. The remaining three (03) residents stated they do not require incontinent care.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

(CONT. on LIC 9099-C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 31-AS-20240222123534

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 LA	FACILITY NUMBER: 197610403
	VISIT DATE: 05/09/2024

NARRATIVE

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--- Staff do not ensure that the facility remains free of odors

It was alleged that visitors can smell that R1 has not been changed. To investigate the allegation, on 02/27/2024, LPA conducted a physical plant tour at around 9:30 AM, interviewed three (03) staff from 10:30 AM to 12:00 PM and interviewed eleven (11) residents from 12:00 PM – 3:00 PM. During the physical plant tour, LPA did not experience any mal odor. During interviews with staff, all staff stated the only time that mal odor exists is when residents are in the process of relieving themselves or when they are changed. Staff added that after changing, the rooms are aired out. During interviews with residents, all residents stated they do not experience mal odor in the facility.

Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff do not follow resident's care plan

It was alleged that R1 is supposed to have their legs elevated but staff are not doing it. To investigate the allegation, on 02/27/2024, LPA interviewed three (03) staff from 10:30 AM to 12:00 PM and interviewed eleven (11) residents from 12:00 PM – 3:00 PM. During interviews with staff, all staff stated that Resident #1’s (R1) legs are being elevated, but that R1 moves their legs after a short time. During interviews with R1, they stated that staff are following the request of having their feet elevated but after a while, they put their feet down and reposition however they please. All other residents stated that the facility is following their care plan.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 6