198602192-5-9-2024-28-AS-RORN-D5JR5N-20240523124325

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602192
Report Date: 05/09/2024
Date Signed: 05/09/2024 05:22:34 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/01/2024 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240501153246

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:	183	CENSUS: 99	DATE:	05/09/2024
		UNANNOUNCED	TIME BEGAN:	09:17 AM
MET WITH:	Janice Shimozawa - Front Desk Receptionist		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff did not provide a safe and comfortable environment for residents
Facility is in disrepair

INVESTIGATION FINDINGS:

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During today's visit, Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial complaint visit to investigate the allegations listed above. LPA met with Janice Shimozawa, Front Desk Receptionist for the facility, and was granted entrance. Current Administrator Jina Malesarkissians arrived shortly thereafter.

The inspection consisted of the following: LPA obtained staff and resident rosters, a copy of the sketch of the facility, interviewed residents #1 - 10 (R1 - R10), and staff #1 - 4 (S1 - S4).

The inspection revealed the following: In regards to the allegation that "Staff did not provide a safe and comfortable environment for residents," it is alleged that homeless people have been entering the facility campus by cutting holes in fencing that surrounds the facility, and they have been squatting in a large abandoned building formerly known as the Intermediate Care Facility (ICF) building that stands next to the main assisted living building for the facility as well as in back lot of the facility.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 28-AS-20240501153246

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SAKURA GARDENS AT LOS ANGELES	FACILITY NUMBER: 198602192
	VISIT DATE: 05/09/2024

NARRATIVE

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During interviews with the residents, one (1) out of ten (10) residents interviewed stated that they have been uncomfortable by the homeless at the facility. This resident stated that about a week ago a homeless individual began came from the ICF building area of the facility and began following the resident, who then proceeded to retreat into the main lobby of the facility due to being uncomfortable. One (1) other resident stated that they have witnessed homeless people staying in the ICF building, however they also indicated that they have not come to the main building on the facility campus. During interviews with the staff, all indicated that homeless have been entering the abandoned ICF building by cutting through the fencing. One staff stated that the ICF building is abandoned and therefore no longer part of the facility campus, however it is true that homeless people have been coming into the campus through fencing next to the ICF building as well as along the back lot of the facility which is connected to the Santa Ana 101 Freeway. This staff further explained that the fencing along the highway belongs to Caltrans, and that they routinely fix the fencing however the homeless continue to cut new holes through the fences. Another staff interviewed stated that they call police whenever a homeless is spotted on the campus, and that they have been advised by other staff to not confront the homeless alone because they may potentially have weapons on them. During the physical plant walk through, LPA observed that there were multiple holes cut into the fencing along the ICF building, as well the fencing along the 101 freeway through which homeless have been coming into the facility campus. LPA also observed that there were rooms along the basement of the facility that had been broken into by the vagrants to use as rooms to sleep in, and found mattresses inside these rooms as well. LPA also observed that there were shards of broken glass along the floor of the main campus of the facility next to the ICF building, which were part of the windows of the ICF building that the vagrants have broken while squatting in the building. The building has graffiti on several walls and broken windows which LPA took a picture of. Additionally, according to the facility sketch obtained by the administrator, the ICF building is still listed as one of the buildings of the facility.

In regards to the allegation that the "Facility is in disrepair," it is alleged that the homeless individuals who have been entering the facility have been stealing the copper wiring from the ICF building as well as from the main back up power generator from the facility as well, as wall as the phone and fax lines which has caused some of the resident phones to not work. During interviews with the residents, two (2) out of ten (10) residents confirmed that their phones were not operational. During interviews with the staff, four (4) out of four (4) corroborated the allegation that the wiring in the facility has been tampered with.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240501153246

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SAKURA GARDENS AT LOS ANGELES	FACILITY NUMBER: 198602192
	VISIT DATE: 05/09/2024

NARRATIVE

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One resident interviewed stated that the phone in her room has not been working for one (1) to two (2) weeks and that it has been very annoying for them. One staff explained that the homeless individuals who have been entering the facility have been stealing the copper wiring from the abandoned ICF building as well as other materials from the building to sell for money. Another staff stated that they have tampered with the AT&T phone box, which has caused disruptions to the phone service for several residents as well as the fax lines for the facility. During the physical plant walk through, LPA observed that the backup power generator the facility has been completely stripped of most of its components, and is therefore not operational at the moment. It has additionally been proven that the fax lines of the facility have not worked for a period of time.

Based on LPAs interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegation, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 are being cited on the attached LIC9099D.

Exit interview held and a copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20240501153246

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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: 05/09/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/24/2024 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator is to ensure that all residents are afforded a safe, comfortable, and healthful environment to reside in. Administrator is to submit her written plan on how the facility will address the issue of homeless individuals entering the facility campus by welding the ICF building's doors,
	8 9 10 11 12 13 14	Based on observation and interview, LPA determined that homeless individuals have been entering the campus of the facility through holes cut into the fencing along the 101 freeway and also along the ICF building, which poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14	erecting iron fencing along the Boyle Street side of the facility which borders the ICF building, by demolition, or other means by the POC due date.
Type B 05/24/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator is to ensure that the facility is in goor repair at all times. Administrator is to submit her plan on how the facility will fix the facility's broken backup power generator, restore the phone and fax lines, and also restore a functional AC unit for the dining hall of the facility by the POC due date.
	8 9 10 11 12 13 14	Based on observation and interview, LPA determined that the facilities phone lines, fax lines, backup power generator, and also dining room AC units have been damaged by individuals stealing their parts, which poses a potential health and safety risk for residents in care.	8 9 10 11 12 13 14

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: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

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