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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602192
Report Date: 02/04/2025
Date Signed: 02/04/2025 01:30:39 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
12/04/2024 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241204135046
FACILITY NAME:SAKURA GARDENS AT LOS ANGELESFACILITY NUMBER:
198602192
ADMINISTRATOR:JINA MALEKSARKISSIANSFACILITY TYPE:
740
ADDRESS:325 S BOYLE AVETELEPHONE:
(323) 263-9651
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:183CENSUS: 128DATE:
02/04/2025
UNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Jina Maleksarkissians AdministratorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff are not following proper infection control protocols with residents in care.
Licensee is not ensuring that the facility is kept free from bed bugs.
Facility is in disrepair.
Licensee does not ensure facility serves food of good quality and quantity to residents in care.
Facility is not adhering to resident(s)' Admission Agreement.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Jina Malekarkissians and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 12/09/2024, LPA interviewed Staff #1- Staff #4, Residents #1 -Residents #5, and toured the facility, LPA obtained copies of the following documents: personnel report LIC 500, resident roster, invoice for pest control, invoices for food purchased, food menu, and physicians reports along with narrative report for three (3) residents. During todays visit LPA Gutierrez interviewed Residents #6- Residents #9, and Staff #5- Staff #6 and obtained copies of elevator maintenance repair receipts, and room change letters.

SEE LIC 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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 3
Control Number 28-AS-20241204135046
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SAKURA GARDENS AT LOS ANGELES
FACILITY NUMBER: 198602192
VISIT DATE: 02/04/2025
NARRATIVE
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In regard to the allegation” Staff are not following proper infection control protocols with residents in care”, it is alleged that residents are having stomach problems resulting in massive diarrhea problems. During interviews with residents all nine (9) stated they had contracted the stomach vires although some residents stated they did hear it was going around. During interviews with staff, it was reported that the 3rd floor did have a stomach bug going around and that signs were posted and that PPE supplies were being used. All staff stated they were following Infection Control protocol.

In regard to the allegation “Licensee is not ensuring that the facility is kept free from bed bugs”, it is alleged that the 3rd floor has bed bugs. During interviews with residents seven (7) out of the nine (9) stated they have not heard of any problems of bed bugs at the facility. R4 stated that they only heard about it but had no problems. During interviews with staff, it was discovered that a resident on the 3rd floor did bring in bed bugs but they facility had Ecolab come in and spay. Administrator stated that it was a is isolated incident and that it did not spread to any other rooms.

In regard to the allegation “Facility is in disrepair”, it is alleged that elevators are non-functioning at certain times, no hot water, or heaters in multiple rooms. During interviews with residents seven (7) out of nine (9) residents stated there are problems with the elevators at times. All nine (9) residents stated there is hot water and working heaters in their bedrooms. During interviews with staff all stated that elevators are old, but they always have at least one elevator working. Administrator stated anytime an elevator does not work they call for repair. LPA was provided monthly maintenance receipts along with repair orders.

In regard to the allegation “Licensee does not ensure facility serves food of good quality and quantity to residents in care”, it is alleged that food is always the same and that the portions are small. During interviews with residents seven (7) out of nine (9) stated there was enough food and their offered a different variety. R8 stated they try to cook Japanese food, but it could be better and that they could always ask for seconds if they are still hungry. During interview with staff five (5) out of the six (6) stated there is enough food and a variety of it. S6 stated they go by the recommended serving amount, but residents can always ask for more if they are still hungry.

SEE LIC 9099C

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20241204135046
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SAKURA GARDENS AT LOS ANGELES
FACILITY NUMBER: 198602192
VISIT DATE: 02/04/2025
NARRATIVE
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In regard to the allegation “Facility is not adhering to resident(s)' Admission Agreement”, it is alleged that residents were moved from 1st floor to another room and rent prices increased. During interviews with residents eight (8) out of nine (9) residents stated they had not moved rooms. R7 stated they did move from 1st floor to 4th floor, but price did not change. During interviews with staff, it was discovered that 1st floor was under remodeling and 1st floor would be adding additional memory care rooms. LPA was provided with letters that were sent to eight (8) residents and family explaining the move with no additional charges.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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, and a copy of this report was given to Administrator Jina Maleksarkissians.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3