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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 07/16/2024
Date Signed: 01/30/2025 11:32:03 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
02/15/2024 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20240215114434
FACILITY NAME:GARDEN OF PALMS LAFACILITY NUMBER:
197610403
ADMINISTRATOR:HIRSCH,RENAFACILITY TYPE:
740
ADDRESS:1025 N FAIRFAX AVETELEPHONE:
(323) 656-7900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:130CENSUS: 106DATE:
07/16/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adam Syncheff, Executive DirectorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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7
8
9
Staff did not prevent resident from having bed bugs
Staff are not providing resident with housekeeping services
Staff are not transporting resident to appointments
Staff are not meeting resident's dietary needs
Staff did not safeguard resident's personal belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an Amendment to the original report issued 07/16/2024. Additional information was added to clarify the investigation.
At 10:00 AM, Licensing Program Analysts (LPAs) Huma Rahimi, Ray Comer conducted an unannounced subsequent complaint visit. LPAs met with the Executive Director and explained the reason for the visit.
An initial visit was conducted on 02/20/2024. At 10:35 AM, LPA requested resident and staff roster. At 10:40am, LPA requested copies of pertinent information which include, but not limited to Physician’s Report, Appraisal Needs and Services Plan, Laundry, and Housekeeping Log, etc., relevant to the investigation. At approximately, 10:45am LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:45am – 2:00pm, LPA conducted an interview with the Executive Director, one (1) MedTech, two (2) staff, one (1) housekeeper, and nine (9) out of ten (10) residents who, were able to communicate. During today’s visit, additional interviews were conducted with Maintenance Supervisor, the Housekeeping Laundry Attendant, and the Kitchen Chef. Continue on LIC 9099

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
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 7
Control Number 31-AS-20240215114434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDEN OF PALMS LA
FACILITY NUMBER: 197610403
VISIT DATE: 07/16/2024
NARRATIVE
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Staff did not prevent resident from having bed bugs:

To investigate this allegation, LPA conducted an interview with the Executive Director who provided documentation of bed bug inspection and pesticide eradication treatment with pest control vendor Orkin Services. On 02/10/24 Pest control vendor, Orkin Services discovered the three (3) resident rooms having bed bugs and were immediately treated. Additionally, the facility ordered an inspection on R1’s and R2’s room for bed bugs with Bugfree Central Company on 06/05/2023; however, R2 refused the entry to their room for inspection to happen. LPA was also informed that the facility has a signed contract with Orkin to provide services monthly to prevent future bed bugs incident from happening. Based on LPA's interview and record review the allegation is SUBSTANTIATED.

Staff are not providing resident with housekeeping services:

During the initial visit on 02/20/2024, LPA conducted interviews with staff and residents. Staff revealed they always provide housekeeping services on daily basis from 8:00 AM to 4:00 PM, Monday to Sunday. Staff also confirmed that the facility also provides deep cleaning services at least once a week to all residents in care. Interviews with residents revealed that the facility does not provide daily or deep cleaning services to residents. Moreover, some residents clean their own rooms. Additionally, LPA observed residents’ rooms dirty and unsanitary. Based on LPA's interview and observation the allegation is SUBSTANTIATED.



Staff are not transporting resident to appointments:

It is alleged that the facility not providing transportation to appointments. LPA's record review revealed that the facility does provide transportation within ten (10) mile radius. Requests for the transportation has to be made 24 hours in advance through the front desk of the facility. Facility staff revealed that there is only one vehicle and one driver available for all residents at the facility. Interview with residents revealed that due to the lack of transportation they missed doctor’s appointments on multiple occasions. LPA was informed that residents were hospitalized since they did not go to their regular doctor’s appointments. Based on the information gathered during this and prior visit, the allegation is SUBSTANTIATED.



Continue on LIC 9099C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 31-AS-20240215114434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDEN OF PALMS LA
FACILITY NUMBER: 197610403
VISIT DATE: 07/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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Staff are not meeting resident's dietary needs

It is alleged that R1 is on a special diet (Soft Mechanical) that the facility does not provide. LPA conducted interviews with Executive Director and Staff #3 (S3) and it was revealed that the facility does provide required dietary needs to R1; however, R2 refuses the meals provided to R1 as indicated by the primary physician on their physician’s report. Interviews with eight (8) out of ten (10) residents confirmed that the dietary services are followed if necessary and did not express any concerns regarding this allegation. On 07/16/2024, an additional interview with the Executive Chef was conducted and LPAs were informed that the facility provides required dietary service to residents to meet their specific needs. Kitchen staff are informed daily for any changes to a resident’s dietary requirements from the facility nurse. Furthermore, they offer alternatives upon request from a resident. Although, the facility does follow dietary needs of the residents, the facility staff did not take an appropriate action when R2 denied and controlled R1’s food. LPA conducted a review of R1’s file and found no documented evidence that R2 had any legal authority for the purpose of decision making on behalf of R1. Based on interviews and record review, this allegation is SUBSTANTIATED.

Staff did not safeguard resident's personal belongings

It is alleged that R1’s wheelchair was either missing or stolen at the facility. To investigate this allegation LPA conducted interviews with Executive Director and staff. It was revealed that R2 left their wheelchair out of their room. The facility staff removed the wheelchair for being a potential hazard and placed it in the storage room to safeguard without notifying R1 and R2. Upon R2’s request, the facility returned the wheelchair back to R1. Additionally, during the initial visit on 02/20/2024, LPA observed the wheelchair in R1’s and R2’s room and R2 informed LPA that their wheelchair was returned as soon as they requested. Although facility returned R1’s wheelchair, interviews with eight (8) out of ten (10) residents revealed that that staff did not safeguard other personal items/belongings and were reported missing. Based on interviews and information gathered, this allegation is SUBSTANTIATED.

Deficiency cited on LIC9099-D.



Exit Interview conducted, appeal rights explained and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
02/15/2024 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20240215114434

FACILITY NAME:GARDEN OF PALMS LAFACILITY NUMBER:
197610403
ADMINISTRATOR:HIRSCH,RENAFACILITY TYPE:
740
ADDRESS:1025 N FAIRFAX AVETELEPHONE:
(323) 656-7900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:130CENSUS: 106DATE:
07/16/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adam Syncheff, Executive DirectorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not providing resident with a comfortable environment
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an Amendment to the original report issued 07/16/2024. Additional information was added to clarify the investigation.
At 10:00 AM, Licensing Program Analysts (LPAs) Huma Rahimi, Ray Comer conducted an unannounced subsequent complaint visit. LPAs met with the Executive Director and explained the reason for the visit.
An initial visit was conducted on 02/20/2024. At 10:35 AM, LPA requested resident and staff roster. At 10:40am, LPA requested copies of pertinent information which include, but not limited to Physician’s Report, Appraisal Needs and Services Plan, Laundry, and Housekeeping Log, etc., relevant to the investigation. At approximately, 10:45am LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:45am – 2:00pm, LPA conducted an interview with the Executive Director, one (1) MedTech, two (2) staff, one (1) housekeeper, and nine (9) out of ten (10) residents who, were able to communicate. During today’s visit, additional interviews were conducted with Maintenance Supervisor, the Housekeeping Laundry Attendant, and the Kitchen Chef.
Continue on LIC-9099
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 31-AS-20240215114434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDEN OF PALMS LA
FACILITY NUMBER: 197610403
VISIT DATE: 07/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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16
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Staff are not providing resident with a comfortable environment:

It is alleged that the facility does not provide adequate cooling in the summer and heating in the winter which is uncomfortable. During the initial visit on 02/20/2024, and today’s subsequent visit, LPAs toured R1’s and R2’s room and random rooms in the facility and found the overall room temperature comfortable enough and compliant to regulation to at least 68 degrees Fahrenheit. Based on LPAs observation during initial visit and today’s visit this allegation is unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Citations on this Visit Report are Under Appeal!

Control Number 31-AS-20240215114434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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: 07/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
07/17/2024
Section Cited
CCR
87303(a)
1
2
3
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5
6
7
Maintenance and Operation: a) The facility shall be clean, safe, sanitary and in good repair.... Maintenance shall include provision of maintenance ....... and visitors.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The licensee addressed the issue with bed bugs by hiring pest control compnay. Moreover, a new maintainence supervisor was hired in place to ensure housekeeping services are being met. POC cleaed during today's visit.
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14
Based LPA observation licensee did not comply with the section sited above by having bed bugs in random rooms, and as well resident's rooms were not being cleaned on regular basis which poses an immediate health and safety risk to residents in care.
8
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Under Appeal
Type A
07/17/2024
Section Cited
CCR
87465(a)(2)
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6
7
Incidental Medical and Dental Care: (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation....shall do so directly or make arrangements for this service.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The Licensee addressed the issue by providing third party transportation to residents in care. Additionally, Executive Director is helping with transportation as neccessary. POC cleared during today's visit.
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Based on LPA interviews with residents licensee did not comply with the section sited above by not providing transportation to residents in timely manner which caused hospitalization of a resident which poses an immediate 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.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 31-AS-20240215114434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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: 07/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
11/14/2024
Section Cited
CCR
87217(b)
1
2
3
4
5
6
7
Safeguards for Resident Cash, Personal Property, and Valuables: (b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables...
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The Licensee/Administrator will conduct an in-service training with all staff regarding this Section. Proof of training will be submitted to LPA by POC date.
8
9
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Based on interviews, licensee did not comply with the section sited above. Eight (8) out of ten (10) residents confirmed their personal items/belongins gone missing, which poses a potential health and safety risk to residents in care.
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10
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14
Type B
11/14/2024
Section Cited
CCR
87461.8(a)(3)
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7
Personal Rights: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) be free from punishment... ...interfering with daily living functions such as eating, sleeping, or elimination.
This requirement is not met as evidenced by:
1
2
3
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5
6
7
Licensee/Administrator agreed to conduct in-service training to all staff regarding this Section and proof of training will be submitted to LPA by POC date.
8
9
10
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12
13
14
Based on LPAs interviews and observation, licensee did not comply with the section cited above by allowing R2 to make a decision on R1's behalf (regarding food) without being a conservator. This poses/posed a potential health and safety risk to residents in care.
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9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7