198603220-4-10-2025-11-AS-UCOL-DHZRSJ-20250626131650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603220
Report Date: 04/10/2025
Date Signed: 04/10/2025 03:49:46 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/03/2025 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250403142558

FACILITY NAME:	CITY VIEW LA, LLC		FACILITY NUMBER:	198603220
ADMINISTRATOR:	GINSBERG, MENDY		FACILITY TYPE:	740
ADDRESS:	515 N LA BREA AVE		TELEPHONE:	(323) 938-2131
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90036
CAPACITY:	166	CENSUS: 105	DATE:	04/10/2025
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Mendy Ginsburg, Executive Director		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff did not ensure medication dispensed to resident was as prescribed
Staff did not meet resident's dietary needs

INVESTIGATION FINDINGS:

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On 04/10/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the above-mentioned facility. LPA was met Mendy Ginsburg, Executive Director (S1), and the purpose of the visit was explained. LPA was granted entry to the facility. S1 and LPA toured the facility.
The investigation consisted of the following:
On 04/10/25 LPA requested and reviewed facility documents, including the following: Personnel Report (dated 03/31/25), resident roster (dated 04/10/25), copy of a resident's face sheet, medication list, and communications between the facility and a resident's primary psychiatrist, along with incident reports regarding a resident. LPA obtained the facilities' diet report of all 105 residents (dated 04/02/25), facilities' dietician's kitchen report for the dates of January, 2025 (01/25) and March, 2025 (03/25) and LPA reviewed facilties' communications between staff and management regarding any changes involving residents and their dietary needs. LPA interviewed six (6) out of one-hundred and five (105) residents (R1-R6) and ten (10) out of seventy-five (75) staff (S1-S10).
Report continues, see LIC9099-C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

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 11-AS-20250403142558

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CITY VIEW LA, LLC	FACILITY NUMBER: 198603220
	VISIT DATE: 04/10/2025

NARRATIVE

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Investigation revealed the following:
Regarding the allegation, "Staff did not ensure medication dispensed to resident was as prescribed". It has been alleged that a resident's medication has been changed without notifying the primary psychiatrist or the responsible parties of a resident. LPA conducted record reviews of the changes mentioned in a resident's medication (MED) list, as follows: LPA reviewed an unusual Incident / Injury Report (LIC624) (dated 03/20/25) noting a resident was observed by staff nine (S9) to have altered behavioral and mental status. On 03/27/25, the resident's primary psychiatrist, sent a new order to this facility. LPA reviewed the facilities' order request on 03/29/25, to the pharmacy. On 04/10/25, between 10:00AM and 1:00PM, LPA interviewed seven (7) staff (S1-S10). S2 and S9 were not present at the facility nor available for LPA's interview call. Between 2:00PM and 4:00PM, LPA interviewed four (4) residents (R2, R4-R6). R1 was not available for interview. R3 preferred not to be interviewed.
All eight (8) staff interviewed (S1, S3-S8, S10) and four (4) out of four (4) residents interviewed (R2, R4-R6) have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has/has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
Regarding the allegation, "Staff did not meet resident's dietary needs". It has been alleged that a resident requires a special diet, as ordered from their physician, and that staff do not follow a residents' special diet. Furthermore, a resident, at times, does not receive a meal from the kitchen. Between 10:00AM - 10:30AM, LPA observed the "diet report" posted in the kitchen. LPA requested facilities' communications between staff and management regarding any changes involving residents and their food and observed those communications between February, 2025 (02/25) and April, 2025 (04/25) which noted six (6) new residents, including their diet plan, and one (1) request to hold nutrition (fasting) for a resident. LPA conducted record reviews of the facilities' diet report and observed 105 residents' dietary restrictions. On 04/10/25, between 10:00AM and 1:00PM, LPA interviewed eight (7) staff (S1, S3). S2 and S9 were not present at the facility nor available for LPA's interview call. Between 2:00PM and 4:00PM, LPA interviewed five (5) residents (R1-R5). R3 preferred not to be interviewed.

Report continues, see LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250403142558

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CITY VIEW LA, LLC	FACILITY NUMBER: 198603220
	VISIT DATE: 04/10/2025

NARRATIVE

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All eight (8) staff interviewed (S1, S3-S8, S10) and four (4) out of four (4) residents interviewed (R2, R4-R6) have denied the allegation has taken place. have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has/has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with staff one, Mendy Ginsburg (S1) and a copy of this report was provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

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