198201933-3-24-2023-11-AS-JHAD-CRJ26X-20230504170751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198201933
Report Date: 03/24/2023
Date Signed: 03/24/2023 04:02:16 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2023 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230316092306

FACILITY NAME:	PALOS VERDES VILLA LLC		FACILITY NUMBER:	198201933
ADMINISTRATOR:	BIENSTOCK, SETH		FACILITY TYPE:	740
ADDRESS:	29661 S WESTERN AVE		TELEPHONE:	(310) 547-9941
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	116	CENSUS: 87	DATE:	03/24/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Seth Bienstock, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not provide adequate food service to the residents while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted an initial complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Angelica Pad, LVN and Seth Bienstock, Administrator.

The investigation consisted of following: Interviews and Record reviews. On 03/24/23, LPA toured the 1st and 2nd floors; rooms 2, 11, 35, 36, 45, 47, & 65, dining room, kitchen and 4 freezer's. The freezer's had plenty of (frozen meats, vegetables, dairy, and frozen fruits/fresh fruits and vegetables.) LPA observed the kitchen staff preparing the lunch meal and serving of meal portions. The 1st lunch meal served had good meat and vegetable portions and it consisted of shrimp, rice and vegetables. The 2nd option meal option consisted of roast beef croissant sandwich and sweet potato fries also good portions. LPA Soto interviewed S#1 - S#6, R#1 - R#6. LPA requested and received the following documents on 03/24/23: Resident Roster, Staff Schedule, R#1 - File (Face sheet, Physician's Report, and Admissions agreement,) menu, and trade menu.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

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 11-AS-20230316092306

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: PALOS VERDES VILLA LLC	FACILITY NUMBER: 198201933
	VISIT DATE: 03/24/2023

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following. For Allegation – Staff do not provide adequate food service to the residents while in care. The interviews conducted with S#1 - S#6, communicated that they all eat at the facility from time to time. They are always served a good amount of food. The facility offers a variety of food and always has 2 options of food to choose from. The residents get 2 choose from 2 options, if the don't like what the 2 options, they are always alternative options. The facility will accommodate resident's choices, if and whenever possible. For those residents that don't come down to the dining area and only eat in their rooms, they have what the facility calls a trade menu. The trade menu offers the same 2 options of food, but they will change the food for other alternative food options. Some residents have restricted or special diets, those residents are given seconds , but they are foods that go along with their diet or restriction. Which sometimes they may like to eat, but need to eat. The staff also communicated that the residents are all have different taste and likes, but the facility always accommodates the residents request and preferences, if and whenever possible. The interviews conducted with R#1 - R#6, communicated that they all like the food. The food is good. The portions are more than enough for them. Sometimes some residents ask for a second serving and the staff brings it to them. They don't have a complaint about the food. They always served different type of food and they are always good. The facility also distributes snacks at 2pm and the servers go around the facility offering the snacks to all the residents. LPA toured the kitchen and dining room. The facility has enough food to feed all the residents. LPA observed the facility lunch meal being served. The meal contained a good portion of meat, vegetable, and starches. LAP also observed soup, salad, and fruits being served before main meal and after main meal. There was a good potion served of the soup bowls, salads plates, and fruits plates. LPA reviewed the Menu and trade Menu, the facility offers a variety of different and healthy meal options. The interviews, observations, records reviewed did not concur with the above allegation.

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 unsubstantiated

An exit interview was conducted with Seth Bienstock, Administrator, and a hard copy of report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC9099 (FAS) - (06/04)

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