198602192-5-11-2021-28-AS-MVAO-C49MTK-20210623095342

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602192
Report Date: 05/11/2021
Date Signed: 05/11/2021 04:31:50 PM

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
08/14/2020 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200814161859

FACILITY NAME:	SAKURA GARDENS AT LOS ANGELES		FACILITY NUMBER:	198602192
ADMINISTRATOR:	KONISHI, DANIEL		FACILITY TYPE:	740
ADDRESS:	325 S BOYLE AVE		TELEPHONE:	(323) 263-9651
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90033
CAPACITY:	177	CENSUS: 120	DATE:	05/11/2021
		UNANNOUNCED	TIME BEGAN:	01:56 PM
MET WITH:	Daniel Konishi		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility air conditioning is broken.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted a subsequent visit to deliver complaint investigation findings. LPA met with Executive Director Daniel Konishi and explained the purpose of the visit.

Investigation consisted of the following: On 8/20/20, LPA conducted a telephone interview with Executive Director Daniel Konishi and requested copies of Staff and Resident Rosters. LPA also received copies of quotes for the following two HVAC companies: Thermal Comfort Systems, Inc dated 12/5/19 for Retirement Home Chiller Repair and Energy Control HVAC (Heating, Ventilation and Air Conditioning) dated 5/21/20 for Compressor #4. On 8/24/20, Executive Director sent LPA an update via email reporting that the facility had hired Retrofit HVAC and also included pictures of a temporary chiller being installed in the facility. On 5/6/21, LPA Luis Mora conducted phone interviews with Residents 2-5 (R2-5) and on 5/7/21 LPA interviewed R1. On 5/11/21, LPA Gonzalez interviewed Executive Director Daniel Konishi.

(See LIC9099C for continuation)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

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-20200814161859

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: SAKURA GARDENS AT LOS ANGELES	FACILITY NUMBER: 198602192
	VISIT DATE: 05/11/2021

NARRATIVE

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The investigation revealed the following: In regards to the allegation, Facility air conditioning is broken, it is alleged that facility air conditioner was broken at or around 8/14/20. It is also alleged that the facility air conditioner had also not been working the previous year (2019). Interview conducted with Executive Director Daniel Konishi revealed that facility air conditioner was not working in the Assisted Living building of the facility and that the air conditioner in the Memory Care building was working perfectly. Mr. Konishi stated that the Assisted Living building HVAC system was having issues due to a defective compressor and the facility had received a quote from a company and would begin working on the issue immediately. On 8/24/20, Mr. Konishi provided LPA with an update that consisted of pictures. The pictures showed the installation of a temporary chiller on 8/22/20. The temporary chiller will remain installed until the new HVAC unit is complete. Mr. Konishi stated that the new HVAC unit was installed on 09/18/2020. Interviews conducted with 1 out of 5 residents revealed that the facility air conditioner had a problem 2 years ago. LPA reviewed copies of two HVAC company quotes for Retirement Home Chiller Repair dated 12/5/19 and for Compressor #4 dated 5/21/20.

Based on interviews conducted with Executive Director Daniel Konishi, resident and LPA review documents, the preponderance of evidence standard has been met; therefore, the above mentioned allegation is found to be SUBSTANTIATED.

Pursuant to the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency was observed and cited during the visit. (Refer to LIC 9099D).

Exit interview was conducted with Executive Director Daniel Konishi. A copy of the report and appeal rights were provided to Executive Director.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200814161859

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: SAKURA GARDENS AT LOS ANGELES	FACILITY NUMBER: 198602192
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/11/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/18/2021 Section Cited CCR 87303(b)	1 2 3 4 5 6 7	87303(b) Maintenance and Operation: A comfortable temperature for residents shall be maintained at all times. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Executive Director to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Executive Director to submit a faxed or mailed copy of POC by due date.
	8 9 10 11 12 13 14	Based on interviews and review of documents that confirmed that the facility air conditioner was not properly working and the licensee did not ensure that the temperatures of resident rooms were kept at a comfortable temperature, which poses a potential safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

LIC9099 (FAS) - (06/04)

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