197610403-10-3-2023-31-AS-TAGD-CZR23Y-20240122160308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 09/06/2023
Date Signed: 10/03/2023 11:59:52 AM

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
08/30/2023 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230830153748

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:	09/06/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Rena Hirsch		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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1. Facility staff is not preventing residents from engaging in physical altercations.
2. Facility does not provide a menu for residents in care

INVESTIGATION FINDINGS:

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This report was amended, to include missing verbiage that needs to be included at the conclusion of the report, and was missing during the initial visit that was conducted on 09/06/2023.....Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Rena Hirsch and informed her the reason of the visit.

During today's visit, LPA met with the Administrator to submit the amended report, that included the additional verbiage. The findings of the investigation will remain the same. The remaining information in the report is from the previous investigation that was conducted on 09/06/2023...LPA conducted a physical plant tour, which included the front lobby, kitchen and dining room. LPA also requested facility documents: resident and personnel roster, activity schedule and daily food menus. LPA interviewed (2) staff, and (9) residents, out of the census of 99. The following was determined:

Allegation # 1: It was alleged that facility staff is not preventing residents from engaging in physical altercations. It was reported to LPA that there was an incident between two residents during a night of Bingo.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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-20230830153748

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: 09/06/2023

NARRATIVE

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According to the interviews, resident # 1 (R1) was being disruptive during the activity, and resident # 2, (R2) grabbed the arm of R1 in attempt to stop the behavior. There was a minor scratch on R1's arm, and staff provided first aid; no further medical attention was required or requested by both residents.
Although there was an incident between two residents, staff and residents reported to LPA that there was no physical altercation and there have been no further incidents between both residents. The facility reported to Licensing, and submitted a SOC341, as well as contacted the primary physician for R1, due to recent medication adjustments. Therefore, based on interviews, the allegation is deemed Unsubstantiated at this time.

Allegation # 2: It was alleged that facility does not provide a menu for residents in care. During today's physical plant tour, LPA observed menus on the front and main door of the dining room. The menu is also posted at the front desk by the receptionist. LPA obtained and reviewed copies of the menu. Residents reported to LPA that the menu is provided in there monthly newsletter, and some of them don't really pay attention to the menus on the door. Although, previously, the menus were placed on each resident's table, the facility has opted to place them on the front doors of the dining room. The facility generates, a daily, weekly and monthly menu; as well as daily available option menu, for those that do not want the meals of the day. LPA observed all (3) menus at the time of the visit. Therefore, based on interviews and facility documents, the allegation is Unsubstantiated at this time.

Exit interview and copy of report provided to Administrator.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC9099 (FAS) - (06/04)

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