197610403-9-26-2023-31-AS-TAGD-D9TN5M-20241007100941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 09/26/2023
Date Signed: 09/26/2023 02:44:40 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.ASC, 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
09/14/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230914123412

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: 99	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Rena Hirsch - Executive Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff are not maintaining the facility in a clean condition
Staff are not ensuring that the facility is free from pests.
Staff are not ensuring that residents have air conditioning

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Gary Tan and Gina Saucedo conducted an unannounced subsequent visit at this facility to further investigate the above allegations. LPAs met with Executive Director Rena Hirsch and explained the reason for the visit.

LPAs conducted physical plant tour at 10:20 AM, requested copies of facility documents relevant to the investigation at 10:45 AM and interviewed residents and staff between 11:05 AM to 1:15 PM. Regarding the allegation that the staff are not maintaining the facility in clean condition, it was alleged that that the facility is filthy and do not clean residents' bedroom. LPA's observation during prior visit on 09/18/23 at 12:00 PM and today at 10:20 AM revealed that the facility is generally clean all over. LPAs visited common areas and random rooms on both ground and second floor including the memory care units and observed to be clean and in proper order. LPAs' interview with a total of nine (9) residents today and on prior visit also revealed that nine (9) out of nine (9) residents stated that the staff clean their bedrooms regularly everyday and do general cleaning once a week. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20230914123412

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDEN OF PALMS LA	FACILITY NUMBER: 197610403
	VISIT DATE: 09/26/2023

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Staff are not ensuring that the facility is free from pests, it was alleged that the facility had bed bugs. LPAs record review revealed that the facility has a contracted pest control company that inspects the facility twice a month to ensure that there is no infestation at the facility. Further review also revealed that Resident #1 (R1)'s room was inspected specifically for bed bugs on 07/11/23 but did not find any bedbugs. LPAs' interview with nine (9) residents or 10% of the current census between 11:05 AM to 1:15 PM revealed that no one among the nine (9) residents interviewed saw or experienced any bed bugs or bed bug bites in their respective rooms.

Regarding the allegation that Staff are not ensuring that residents have air conditioning, it was alleged that air conditioner has been turned off deliberately, LPA's interview with the Executive Director today at 12:30 PM revealed that they some of the residents are complaining that they are hot and some are cold so they are having a hard time adjusting the right temperature but they maintain the temperature setting between 72°F to 78°F and that there is no recent disrepair of the air conditioning unit at the facility. LPA's interview with the maintenance director on 09/18/23 at 1:00 PM, revealed that air conditioning unit are set on auto mode, which means that it is automatically turns on and off based on the setting which is between 72°F to 78°F . LPAs interview with nine (9) residents between 11:05 AM to 1:15 PM revealed that all nine (9) residents stated that they did not have any problem with the air conditioning unit in their respective rooms.

Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
09/14/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230914123412

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: 99	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Rena Hirsch - Executive Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff are not addressing residents' health conditions while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Gary Tan and Gina Saucedo conducted an unannounced subsequent visit at this facility to further investigate the above allegetions. LPAs met with Executive Director Rena Hirsch and explained the reason for the visit.

LPAs conducted physical plant tour at 10:20 AM, requested copies of facility documents relevant to the investigation at 10:45 AM and interviewed residents and staff between 11:05 AM to 1:15 PM.

Further investigation is required at this time.

Exit interview conducted. Copy of this report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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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