197610403-6-16-2024-31-AS-NMAN-D9HVT8-20240927164242

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 06/16/2024
Date Signed: 06/16/2024 02:38:04 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
01/04/2024 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20240104170516

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:	06/16/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Solange Nkafu/Wellness Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing program Analyst (LPA) Tihesha Smith made an unannounced complaint visit to this facility to deliver findings. The administrator was not present at the facility. LPA met with staff and disclosed the purpose of the visit.

Facility did not safeguard resident's personal belongings
It was alleged that facility did not safeguard resident's personal belongings. Resident # 1 (R1) states that their passport and computer were missing when they returned to the facility 01/04/24. During initial visit on 01/09/24, LPA Smith conducted a short tour of the facility, interviewed staff, Resident #1 (R1), and review facility records reviewed from approximately 12:05 pm to 1:00 pm. R1 is no longer a resident at the facility. During today's visit, LPA Smith interviewed staff, residents and requested records. During interview with R1 on 01/09/24, R1 revealed was homeless prior to admission to facility. When LPA asked R1 about their belongings, R1 was unable to give the color of their
(Cont to 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2024

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-20240104170516

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: 06/16/2024

NARRATIVE

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(Cont. from 9099)

passport book or give the make, model, and color of the computer that was allegedly missing. LPA ended the interview with R1 when R1 began to have a behavior episode. Interviews with five (5) of five (5) available staff reveal the facility and or staff does not safeguard residents’ personal belongings as each resident’s belongings are stored in their own rooms. Interviews with (6) of eleven (11) residents revealed personal belongings are stored in their rooms not by facility and they have not had any of their belongings missing at the facility. Two (2) of eleven (11) residents revealed had some items misplaced but items were later found in their room.

Based on interviews, there is insufficient evidence to support the allegation Facility did not safeguard resident’s personal belongings. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted/Copy of report given.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2024

LIC9099 (FAS) - (06/04)

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