198601054-8-25-2021-28-AS-LHIS-C6TP2K-20210913105600

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601054
Report Date: 08/25/2021
Date Signed: 08/25/2021 02:08:30 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
08/17/2021 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210817142524

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: 78	DATE:	08/25/2021
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Elena Novikova, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff did not keep facility free from mildew.
Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Cynthia Chan and Jewel Baptiste conducted a complaint investigation for the allegations listed above. LPAs met with Administrator, Elena Novikova and explained the purpose of the visit.

During today’s visit, LPAs toured the facility with the Administrator and inspected the following 10 client rooms along with the private or community bathrooms: Rooms #A5, #B2, #B7, #C1, #C2, #C3, #C4, #D3, #E4, and #G9. LPAs interviewed the Administrator, 4 Staff, and 12 Residents. LPAs also obtained a copy of the staff and client roster.

Regarding allegation - Staff did not keep facility free from mildew. During today's visit, LPAs selected 10 client rooms for the walk through. Some of the rooms consisted of a private bathroom, while others use the community bathroom. LPAs did not observe any mold or mildew in either the closets nor the bathtubs/showers. The Administrator along with 4 Staff interviewed have not seen any mildew nor heard any clients report of mildew. (Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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-20210817142524

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: 08/25/2021

NARRATIVE

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LPAs interviewed 12 clients today. 2 out of the 12 clients stated they had seen mildew in the bathroom, but also stated that the staff immediately cleaned it up.

Regarding allegation - Facility is in disrepair. LPAs randomly selected 10 client rooms and bathrooms to inspect. LPAs did not find any bathroom fixtures coming apart or flooring in disrepair. Based on interviews conducted with the Administrator and Staff members, they would fix anything in disrepair right away or within a day or two. The Office Manager conducts weekly walk through of the facility to ensure that everything is working properly. If there are any issues, they would contact a maintenance personnel to assist with the repair if staff are unable to fix immediately. LPAs interviewed 12 clients who either stated that they have not had anything in disrepair lately or that if something was broken, the staff would fix it within a day or two.

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. A copy of this report and appeal rights were left with the Administrator whose signature on this form confirm receipt of these documents.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC9099 (FAS) - (06/04)

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