197610403-9-18-2024-31-AS-NMAN-D9MQXC-20241001123316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 09/18/2024
Date Signed: 09/18/2024 02:25:42 PM

Unsubstantiated

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
10/25/2023 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20231025122256

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: 104	DATE:	09/18/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Administrator, Adam Syncheff		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff are not administering medication(s) to resident(s) as prescribed by their physician
Staff are not ensuring that resident's dietary restrictions are being met
Staff do not respond to resident(s) requests for assistance in a timely manner

INVESTIGATION FINDINGS:

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At 10:15am Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted unannounced complaint visit to the facility to complete investigation of the above noted allegations and to deliver final report. At 10:30am LPA met with the Administrator.

To investigate the above noted allegations, during initial visit conducted on 10/27/23, LPA requested facility records at 10:30am. The documents included, but not limited to staff and resident roster, residents (R1 - R2) physician report, needs and service plan and pertinent documents relevant to the investigation. At the time of visit between 10:45 am – 1:00 pm LPA and Administrator toured the physical plant and at approximately 1:05pm LPA spoke with Administrator, Staff (S1), and four (4) Residents (R1-R4). LPA Alvizar asked questions relevant to the nature of the complaint.

Staff are not administering medication(s) to resident(s) as prescribed by their physician.

Cont. LIC9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

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-20231025122256

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: 09/18/2024

NARRATIVE

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It is alleged that R2 is not receiving the appropriate blood pressure and diabetes medications. R#2 is not receiving appropriate cancer care and has been mislabeled, because of dementia and subsequently placed on hospice care. LPA interview ten (10) out of one hundred – four (104) residents including Resident’s R1 and R2. R1 agreed with the allegation and R2 did not respond. The other resident that where interview revealed that they did not have any concerns about the allegation. Administrator and other staff indicated only R1, who is R2’s spouse, orders R2’s medication refill and when medication arrives to facility, Med – Techs takes it to room and R1 receives it. Staff interview revealed that R1 does not allow Med – Tech’s to administrator R2’s medication.

Prior to this visit LPA Alvizar-Ettima reviewed facility records including Physician Report and Preplacement Appraisal Information. The information revealed from records supported the information provided by the facility personnel. According to record review R2’s primary diagnosis is unspecified dementia and R2 currently is under hospice.

Based on interviews and record review, there is no pertinent information to support the allegation. Therefore, the allegation are deemed UNSUBSTANTIATED at this time.

2.) Staff are not ensuring that resident's dietary restrictions are being met.

It is alleged that food they receive does not honor their dietary restrictions and the quality of the food is poor. LPA Alvizar - Ettima interview with Resident (R1) who stated that R2 cannot have citrus food and staff continue to provide it. R2 did not provide a response to the allegation. Interview with eight (8) out of one hundred and four (104) residents did not have any concerns regarding quality and variety of food served at the facility. Six (6) out of the eight (8) residents indicated that the food was good, and they liked the chicken and fish. Administrator indicated that facility staff are ensuring that they follow R2’s (No Added Salt) dietary restriction. During initial inspection LPA observed the “AL Special Diet” list posted in the kitchen board. The list identifies all residents that are under special medical diet.

Prior to this visit LPA Alvizar-Ettima reviewed facility records including “AL Special Diet”. According to record review R2 is in a “no added salt diet”. There was no dietary restriction for “citrus food”.
The information revealed from records supported the information provided by the facility personnel.

Based on interviews and record review, there is no pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Cont. LIC 9099c

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20231025122256

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: 09/18/2024

NARRATIVE

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3.) Staff do not respond to resident(s) requests for assistance in a timely manner.

It is alleged that staff taken hours to respond to calls for assistance and due to insufficient staff to meet appropriate care needs of residents, there is a long delays in obtaining assistance.

During inspection conducted at the time of initial visit, LPA randomly selected six (06) out of one hundred - four (104) residents and the call buttons were tested in their rooms. All call buttons appeared to be functional, and LPA observed staff answering to call between two (2) to three (3) minutes.
LPA Alvizar - Ettima interview with Resident (R1) revealed that staff does not respond to the call button on time. R2 did not provide a response to the allegation. Staff interviews reveal that they do respond to resident(s) request for assistance in a timely manner. The Call LIght system was recently upgraded. Administrator indicated that R1 sometimes refuses assistance from staff for themselves and R2, because R1 only requested certain staff to assistance. Interviews with eight (8) out of one hundred – four (104) residents indicated that staff do respond to their request for assistance.

Prior to this visit LPA Alvizar-Ettima reviewed facility records including “Important Notice - Call Light System will be upgraded. The information revealed from records supported the information provided by the facility personnel.

Based on observation, interviews and record review there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazard is noted during this visit.

Exit interview is conducted and copy of report was provided to Administrator.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC9099 (FAS) - (06/04)

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