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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602192
Report Date: 02/08/2024
Date Signed: 02/08/2024 04:51:54 PM

Substantiated


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
11/20/2023 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231120121606
FACILITY NAME:SAKURA GARDENS AT LOS ANGELESFACILITY NUMBER:
198602192
ADMINISTRATOR:KONISHI, DANIELFACILITY TYPE:
740
ADDRESS:325 S BOYLE AVETELEPHONE:
(323) 263-9651
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:183CENSUS: 134DATE:
02/08/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Rodora Marina Merana, Memory Care DirectorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff interfere with resident's sleep.
Staff do not properly store residents' personal hygiene care items.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to investigate the above allegations. The purpose of the visit was explained to receptionist Janice Shimozawa. The facility does not currently have an Executive Director. Rodora Marijna Merana arrived later and assisted with today's visit.

The investigation consisted of the following: On 11/28/2023, LPA conducted a tour of the facility with focus on the Memory Care Units and one staff was interviewed. The Neurocognitive Disorder Care Plan of of Operation, Designation of Facility Responsibility,Personnel Records and training, LIC 500 Personnel Report, and resident rosters were obtained. Photographs were taken of the storage rooms were resident's hygiene products were being stored. During today's visit, LPA obtained Dementia Care Plan of Operation [Service Plans, Resident Dining, Northstar Food Service, and kitchen meal time schedule. A tour of the facility and Memory Care Unit was conducted, 7 staff were interviewed, and room observations were made.

***Narrative continues next page.***

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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 5
Control Number 28-AS-20231120121606
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: 02/08/2024
NARRATIVE
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Allegation: Staff interfere with resident's sleep. It was reported that NOC shift staff wake up Memory Care residents between the hours of 4:30 AM - 5:00 AM in order to get them ready for breakfast and before the AM shift starts. A total of eight (8) staff were interviewed, of which five (5) out of eight (8) staff stated that the NOC shift staff wake up the residents between 4:30 AM - 5:00 AM, and start changing the residents in order to get them ready for breakfast meal time. After they are changed they are taken to the activity room at 6:00 AM. Their breakfast time is 6:30 AM. According to Memory Care Director, some Memory Care unit residents are already awake at that time. However, the majority of the staff interviewed stated that they feel the residents are awakened too early, and the primary reason for the protocol is to have the residents ready before the AM shift begins at (6:00 AM). Staff reported that sometimes residents are sleepy and fall asleep in the activity room tables. Therefore, the resident's sleep is being affected. Family interviews revealed that they did not have knowledge of the resident wake-up time and also reported that the resident are put to bed early in the evening, usually by 7:00 PM. Former Administrator Daniel Konishi was not interviewed. Assisted Living residents have Personal Rights that state they are to be free from....actions of a punitive nature, such as... interfering with daily living functions such as eating, sleeping, or elimination.

Allegation: Staff do not properly store residents' personal hygiene care items. It is alleged that resident's hygiene box and toothbrushes are stored in the laundry room/cleaning tools storage room. A total of eight (8) staff were interviewed. All confirmed the allegation. They stated the hygiene products have been stored there for a long time because the Memory Care unit does not have enough storage areas. They stated that the laundry room is cleaned every 2 months. On 11/28/2023, LPA observed the storage room and confirmed the allegation. Toothbrushes and incontinence supplies were stored uncovered and the room contained cleaning supplies, dirty laundry, and had dirty floors. Pictures were taken.

Based on interviews conducted and document review, the preponderance of evidence standard has been met, therefore the above allegation are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22. See LIC 9099D.

An exit interview was conducted with Memory Care Director Rodora Merana.A copy of the report and appeal rights were issued.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20231120121606
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: 02/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2024
Section Cited
CCR
87468.1(a)(3)
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Personal Rights of Residents in All Facilities. To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
This requirement was not met evidenced by:
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Licensee shall ensure that the Memory Care Unit staff are trained in Personal Rights and are familiar with Dementia Care Plan of Operations.
Submit written proof of how the defiicency was corrected, and staff training staff sign-in sheets. NOTE: Training must be done by a Certified Administrator/qualified person.
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Based on interviews conducted, the findings indicate that Memory Care NOC shift staff are waking up the residents between 4:30 AM - 5:00 AM, in order to get them ready and transported to the dining room at 6:00 AM, which interferes with sleeping. This poses a potential health and safety risks to persons in care.
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Type B
02/15/2024
Section Cited
CCR
87303(g)(1)
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Maintenance and Operation. Facilities which have machines and do their own laundry shall: ... Except for facilities licensed for fifteen (15) residents or less, the space used to do laundry shall not be part of an area used for storage of anything other than clean linens and/or other supplies normally associated with laundry activities. Steam, odors, lint and objectionable laundry noises shall not reach resident or employee areas
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Licensee shall ensure the laundry room is only used for associated laundry activities, and not as a storage room for resident's hygiene products or incontinence supplies.
Submit picture proof of correction, and proof of staff training.
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Based on observation, the laundry room is being used as a storage room for resident's hygiene products i.e. toothbrushes, incontinence care; which poses a potential health and safety risk to persons in care.
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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: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
11/20/2023 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231120121606

FACILITY NAME:SAKURA GARDENS AT LOS ANGELESFACILITY NUMBER:
198602192
ADMINISTRATOR:KONISHI, DANIELFACILITY TYPE:
740
ADDRESS:325 S BOYLE AVETELEPHONE:
(323) 263-9651
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:183CENSUS: 134DATE:
02/08/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Rodora Marina Merana, Memory Care DirectorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
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7
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9
Staff do not provide residents with a reasonable amount of time to consume meals.
Licensee does not ensure facility administrator has an active administrator certificate.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
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12
13
Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to investigate the above allegations. The purpose of the visit was explained to receptionist Janice Shimozawa. The facility does not currently have an Executive Director. Rodora Marijna Merana arrived later and assisted with today's visit.

The investigation consisted of the following: On 11/28/2023, LPA conducted a tour of the facility with focus on the Memory Care Units and one staff was interviewed. The Neurocognitive Disorder Care Plan of of Operation, Designation of Facility Responsibility,Personnel Records and training, LIC 500 Personnel Report, and resident rosters were obtained. Photographs were taken of the storage rooms were resident's hygiene products were being stored. During today's visit, LPA obtained Dementia Care Plan of Operation [Service Plans, Resident Dining, Northstar Food Service, and kitchen meal time schedule. A tour of the facility and Memory Care Unit was conducted, 7 staff were interviewed, and room observations were made.

***Narrative continues next page.***
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20231120121606
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: 02/08/2024
NARRATIVE
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Allegation: Staff do not provide residents with a reasonable amount of time to consume meals. It is alleged that Memory Care staff rush the residents during mealtimes and are often heard asking the residents "Are you done" in an impatient manner. Additionally, it was reported that staff do not always provide feeding assistance to residents and say that the residents did not want to eat and put the food back in the tray for removal. Three (3) out of eight (8) staff stated they do rush residents because the dining room staff want the meal trays by a certain time. One (1) staff stated that staff rush the residents and purposely feed the residents large spoonful’s so they can finish their meals faster. LPA observed several mealtimes and did not observe staff rushing the residents. Based on staff interviews, there is insufficient evidence to corroborate the allegation.

Allegation: Licensee does not ensure facility administrator has an active administrator certificate. It is alleged that the Memory Care Director does not have an Administrator's certificate but is saying that they are an Administrator. It was also reported that Administrator Daniel Konishi delegates all Memory Care responsibilities to the Director and is not in charge of the facility. Based on record review, the findings indicate that the Memory Care Director does not have an Administrator Certificate. However, Executive Director Daniel Konishi has an active Administrator Certificate that expires 04/28/24.



Note: Executive Director Daniel Konishi last day of employment at the facility was January 31, 2024. According to Title 22 Reporting Requirements 87211(g) The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator....

Based upon record review and interviews conducted the findings indicate that, 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.

Exit interview was conducted with Memory Care Director Rodora Merana. A copy of the report was issued.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5