198320378-11-1-2023-11-AS-MVAO-D3BRBJ-20240313125248

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320378
Report Date: 10/27/2023
Date Signed: 11/01/2023 03:19:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
10/26/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20231026162040

FACILITY NAME:	HOLIDAY VILLA		FACILITY NUMBER:	198320378
ADMINISTRATOR:	ZENOU, ADAM		FACILITY TYPE:	740
ADDRESS:	1447 17TH STREET		TELEPHONE:	(310) 829-5904
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	174	CENSUS: 37	DATE:	10/27/2023
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Amber Lollar		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility is not maintaining a comfortable temperature for residents in care.
Staff did not ensure that facility vents were cleaned.
Facility laundry appliances are in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Friday, October 27, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Wellness Director Amber Lollar. LPA Bunker explained the purpose of today's visit.
The investigation consisted of the following: Interviews were conducted with staff members 1-5 (S1-S5) and residents 1-5 (R1-R5). LPA Bunker posed relevant inquiries pertaining to the nature of the complaint. Accompanied by Ms. Amber, LPA Bunker inspected the laundry room, meticulously assessing the operational status of the washers and dryers. We diligently inspected the facility's ventilation system and air filters. The facility's thermostat was verified to be set at a comfortable room temperature of 74 degrees. During the visit, LPA Bunker carefully assessed the cleanliness, safety, sanitation, and general state of repair of the facility's vents, all of which were found to be in compliance with Title 22 Regulation standards, promoting the safety and well-being of clients, employees, and visitors. LPA Bunker formally requested copies of the staff and residents' roster. See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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-20231026162040

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HOLIDAY VILLA	FACILITY NUMBER: 198320378
	VISIT DATE: 10/27/2023

NARRATIVE

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Continued LIC9099-C page 2
Allegation #1: Facility is not maintaining a comfortable temperature for residents in care. Staff members 1-5 (S1-S5) and residents 2-5 (R2-R5) unequivocally affirmed that the facility consistently maintains a comfortable room temperature for its residents. S1-S5 and R2-R5 further affirmed that the facility's environment remains cool, ensuring a comfortable range, even lower than the ambient outside temperature. Additionally, S1-S5 and R2-R5 stated that staff proactively adjust the thermostatic controls to ensure residents are comfortable at all times. During our investigation, we meticulously examined the facility's room temperature and confirmed that the thermostat was set at a comfortable 74 degrees. However, Resident 1 (R1) raised a concern, asserting that the temperature inside the facility reached an uncomfortably high 94 degrees.

Allegation #2: Staff did not ensure that facility vents were cleaned. S1-S5 and R2-R5 asserted that the facility's vents are consistently cleaned, with no residents experiencing bronchial cough symptoms. S1-S3 stated they had no physician reports, medical records, or documentation indicating residents with bronchial cough issues. S5 attested to taking proactive measures by cleaning the vents, replacing filters, and ordering new ones. S5 stated the facility underwent a change in ownership, and the previous owner had engaged an AC company to service all 17 units. S5 stated he is currently in charge of maintenance, and assured that the vents are clean, and filters have been ordered and replaced. Our inspection confirmed the operational condition of the facility's ventilation system and air filters. R1 contended that the facility's vents had not been cleaned and filters had not been changed, resulting in residents developing bronchial cough symptoms. S1-S5 and R2-S5 staunchly denied this allegation.

Allegation #3: Facility laundry appliances are in disrepair. S1-S5 and R2-R5 affirmed that the facility's washers and dryers are fully operational, with housekeeping staff washing residents' clothing and linen on a daily basis or as needed. Our inspection of the facility's washer and dryers validated their working condition. However, R1 claimed that the facility's washing machine and dryers were non-functional. S1-S5 and R2-S5 firmly refuted this allegation.

Investigation revealed the following: The investigation yielded consistent responses from staff members 1-5 (S1-S5) and residents 2-5 (R2-R5), all of whom adamantly denied the veracity of the allegations. S1-S5, in particular, emphasized the facility's commitment to maintaining a comfortable room temperature for residents, ensuring the cleanliness of vents, and upholding the functionality of laundry room appliances. Our inspection further corroborated these assertions, as the ventilation system and air filters were found to be both clean and operational, and the laundry room's washers and dryers were in working order.
Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated. There were no deficiencies cited. Exit interview conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC9099 (FAS) - (06/04)

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