<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 09/19/2023
Date Signed: 09/19/2023 04:01:45 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
08/11/2023 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20230811100354
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: 99DATE:
09/19/2023
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Rina Hirsch, Executive DirectorTIME COMPLETED:
04:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not make sure resident had equal share of space in the room.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with the administrator, Rena Hirsch, and explained the reason for the visit.

--- Staff did not make sure resident had equal share of space in the room.

It was alleged that Resident #2 (R2) is not sharing the living space equally with Resident #1 (R1) . To investigate the allegation on 08/18/2023, LPA conducted physical plant tour at around 10:00 AM, LPA interviewed four (04) staff and nine (09) residents between 11:30 AM to 03:30 PM. LPA observed that R2’s belongings occupied most of the space in the room and R2 occupied both refrigerators of which one was for R2. During interviews with staff, all staff stated that R2 does not like sharing the room, does not allow others to enter the room and occupies most of the living space.
(Cont. on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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-20230811100354
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: 09/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During interviews with residents, R1 stated that R2 did not share the room fairly and that R1 does not like to share the living space and refrigerator. All other residents stated that they do not have any issues regarding the sharing of their living space or appliances.

Based on observations and 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 and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 31-AS-20230811100354
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: 09/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/22/2023
Section Cited
CCR
87307(d)(1)
1
2
3
4
5
6
7
Personal Accommodations and Services(d)The following space and safety provisions shall apply to all facilities: (1) Sufficient room shall be available to accommodate persons served in comfort..This requirement is not met as evidenced by; Based on observations
1
2
3
4
5
6
7
The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87307 Personal Accommodations and Services; The written letter must be sent to the LPA by the POC due date.
8
9
10
11
12
13
14
and interviews, the facility did not ensure R1 had sufficient room available to accommodate with comfort & safety as they were not allowed equal living space and refrigerator access in the bedroom. This poses a potential health, safety and personal rights risk to residents in care.
8
9
10
11
12
13
14
Request Denied
Type B
12/06/2023
Section Cited
CCR
87468.1(a)(13)
1
2
3
4
5
6
7
Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (13)To have access to individual storage space for private use. This requirement is not met as evidenced by;
1
2
3
4
5
6
7
The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87468.1 Personal Rights of Residents in All Facilities; The written letter must be sent to the LPA by the POC due date.
8
9
10
11
12
13
14
Based on observations and interviews, the facility did not ensure R1 had access to individual storage space for private use. This poses a potential health, safety and personal rights risk to residents in care.
8
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: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC9099 (FAS) - (06/04)
Page: 3 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
08/11/2023 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20230811100354

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: 99DATE:
09/19/2023
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Rina Hirsch, Executive DirectorTIME COMPLETED:
04:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is emotionally black mailing residents.
Staff did not replace resident's medication.
Staff are not providing a comfortable environment for resident.
Staff are not safeguarding resident's personal belongings.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with the administrator, Rena Hirsch, and explained the reason for the visit.

--- Staff is emotionally black mailing residents.
It was alleged that Resident #1 (R1) was asked by staff not to file a complaint to licensing. To investigate the allegation on 08/18/2023, LPA interviewed four (04) staff and nine (09) residents between 11:30 AM to 03:30 PM. During interviews with staff, all staff stated they have never instructed or asked any resident not to file a complaint to any agency. During interviews with residents, all residents stated that they have never been instructed or asked by staff not to file a complaint to licensing or any other agency.

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)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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 6
Control Number 31-AS-20230811100354
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: 09/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
--- Staff did not replace resident's medication.

It was alleged that facility did not replace R1’s medication which required refrigeration. To investigate the allegation on 08/18/2023, LPA interviewed four (04) staff and nine (09) residents between 11:30 AM to 03:30 PM. During interviews with staff, all staff stated after non-refrigeration of R1’s medication was brought to their attention, they immediately refrigerated it and has not been used by R1 to date. During interviews with residents, all residents stated that they have never encountered any problems with medications or the replacement of medication for any reason.

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

--- Staff are not providing a comfortable environment for resident.

It was alleged that R1 is unable to sleep because their roommate has night terrors and screams at night. To investigate the allegation on 08/18/2023, LPA interviewed four (04) staff and nine (09) residents between 11:30 AM to 03:30 PM. During interviews with staff, all staff confirmed R1’s roommate has night terrors, but the physician was immediately made aware, and resident is now taking medication to sleep through the night. During interviews with residents, R1 stated that they have not been able to get a good night’s sleep because of the screaming during night terrors. All other residents stated that they are unaware of any such screaming at night. Although resident experiences night terrors, facility took steps to notify the physician and resolve the issue through medication.

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)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 31-AS-20230811100354
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: 09/19/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
--- Staff are not safeguarding resident's personal belongings.

It was alleged that staff use R1’s soap and shampoo for their roommate. To investigate the allegation on 08/18/2023, LPA interviewed four (04) staff and nine (09) residents between 11:30 AM to 03:30 PM. During interviews with staff, all staff stated they never use other residents’ products or supplies to provide care to other residents, that each resident has their own supplies and facility has supplies for those that do not have their own. During interviews with residents, all residents stated staff have never used their personal supplies to provide care to other residents.

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 and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6