198601054-4-4-2022-28-AS-SCOL-CFSU65-20220627151746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601054
Report Date: 04/04/2022
Date Signed: 04/04/2022 02:31:42 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/01/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220401135020

FACILITY NAME:	PARKVIEW MANOR		FACILITY NUMBER:	198601054
ADMINISTRATOR:	CHERTOK, VLADAMIR		FACILITY TYPE:	735
ADDRESS:	5055 NOVGOROD STREET		TELEPHONE:	(323) 225-4293
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90032
CAPACITY:	86	CENSUS: 74	DATE:	04/04/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Elena Novikova, Administrator		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Residents are locked in the facility.
Food is not of quality.
Staff not ensuring residents are provided an adequate amount of drinking liquids.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted the initial complaint investigation for the allegations listed above. LPA arrived unannounced and met with Administrator, Elena Novikova. The reason for the visit was explained.

LPA conducted a tour of the facility inside and out with the Administrator and obtained a copy of the staff roster, client roster, and weekly food menu. There is a total of 6 buildings and LPA randomly selected 8 rooms to inspect. LPA inspected the food supplies and observed sufficient 2-day perishable and a week of nonperishable. LPA also interviewed the Administrator, 4 Staff and 9 Clients. There were no immediate health and safety concerns during the visit today.

Regarding allegation – Clients are locked in facility. There are 2 gates at the facility, one on Novgorod St. and another on Jennings Dr.
(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2022

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 28-AS-20220401135020

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PARKVIEW MANOR	FACILITY NUMBER: 198601054
	VISIT DATE: 04/04/2022

NARRATIVE

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Due to the Coronavirus (COVID-19) pandemic and Community Care Licensing COVID-19 guidance, the facility kept one entry and exit point to monitor and properly screen individuals coming into the facility. Per the Administrator, the clients are not locked in the facility and can go in and out when they want. She stated the big gate is closed not locked after curfew hour at 10pm, but clients can enter and exit through the smaller side gate on Jennings Dr. LPA observed both big and small gates opened without any locks for their current entry point. The Staff interviewed also stated that the gates on Jennings Dr. are not locked even after curfew hours. All nine (9) clients interviewed stated the main gate is kept unlocked and can come and go as they please.

Regarding allegation – Food is not of quality. LPA toured the kitchen and observed a variety of meats and vegetables. The menu was obtained and reviewed by LPA who observed a variety of meats offered and different items from each food group. LPA was present during lunch time and observed clients being served a good portion of food which includes a hot dog, macaroni salad, and a piece of pineapple. Per the cook, clients can obtain additional servings if they are still hungry. The cook follows the menu that it posted so clients will know what is being served. If a client does not like the food during the mealtime, the cook will provide an alternative such as a sandwich for the client. The Administrator stated the menu is created with consideration of those who are diabetic. The menu and everything related to the kitchen are inspected monthly by a dietitian. Per the office manager, she does the grocery shopping every Tuesday for the week and ordered the meat items for the month today. Eight (8) out of nine (9) clients interviewed stated the food served are good and of good quality. They serve a good amount and offer a variety. One client was not sure if the quality of food is good as the facility is serving a bologna sandwich without cheese and/or a grilled cheese sandwich with minimal amount of cheese inside.

Regarding allegation – Staff not ensuring clients are provided an adequate amount of drinking liquids. LPA observed a gallon of drinking water by the main office and another in building “G”. The Administrator and staff stated the containers are checked often to ensure there is always water for clients to consume. In addition to water, clients are also provided liquids such as coffee, milk, tea, and/or juice during mealtime and snack time. All nine (9) clients interviewed stated the facility provides adequate amount of drinks and can access water located by the front office anytime they want.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with the Administrator. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2022

LIC9099 (FAS) - (06/04)

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