198603220-4-15-2025-11-AS-UCOL-DJVLU2-20250724090309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603220
Report Date: 04/15/2025
Date Signed: 04/15/2025 03:46:26 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
04/10/2025 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250410144015

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:	04/15/2025
		UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Vanita Harris, Business Office Manager		TIME COMPLETED:	04:39 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not assist resident with getting off the floor
Staff did not check on resident in a timely manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 04/15/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the facility. LPA was met by staff one, Vanita Harris Business Office Manager (S1), and the purpose of the visit was explained. LPA was granted entry to the facility.
The investigation consisted of the following: On 04/07/25 LPA printed personnel report summary. On 04/10/25 LPA obtained the Personnel Report (dated 03/31/25), resident roster (dated 04/10/25). On 04/15/25 LPA toured the first, second and fourth (1st, 2nd & 4th) floors of the facility. On 04/15/25 LPA requested and reviewed facility documents, including copies of face sheets, Needs and Services plan, Physician's reports of three (3) resident's (R1-R3). LPA also obtained staff schedule for the month of April, 2025 (printed 04/15/25). LPA requested four (4) staff records (S2, S5-S6, S8) and between 09:40AM and 1:00PM LPA interviewed five (5) staff (S1-S5) and between 2:00PM and 4:30PM LPA interviewed three (3) staff (S6-S8), four (4) residents (R1-R4) and one witness (W1). R4 was not available to be interviewed, due to current medical status. S1 was not able to answer LPA's questions, as that is beyond their work duties.
Report continues, see LIC9099-C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

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 2

Control Number 11-AS-20250410144015

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: 04/15/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Investigation revealed the following:
Regarding the allegation, “Staff did not assist resident with getting off the floor”. It has been alleged that a resident was not assisted out from being stuck between the bed and night stand for an extended period.
Record reviews revealed that four (4) staff (S2, S5-S6, S8) present on the date in question have conducted all required training as a caregiver and as a Med-Tech.
Between 09:40AM and 1:00PM LPA interviewed five (5) staff (S1-S5) and between 2:00PM and 4:30PM LPA interviewed three (3) staff (S6-S8), four (4) residents (R1-R4) and one witness (W1). R4 was not available to be interviewed, due to current medical status. S1 was not able to answer LPA's questions, as that is beyond their work duties. Seven (7) out of Eight (8) staff (S2-S8), Three (3) out of three (3) residents (R1-R3) and one (1) witness (W1) interviewed have denied the allegation has taken place. Seven (7) out of Eight (8) staff (S2-S8) have provided accurate details on emergency protocol.
Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
Regarding the allegation, “Staff did not check on resident in a timely manner”. It is being alleged that a resident was discovered stuck between the bed and night stand. Record reviews revealed that four (4) staff (S2, S5-S6, S8) present on the date in question have conducted all required training as a caregiver and as a Med-Tech.
Between 09:40AM and 1:00PM LPA interviewed five (5) staff (S1-S5) and between 2:00PM and 4:30PM LPA interviewed three (3) staff (S6-S8), four (4) residents (R1-R4) and one witness (W1). R4 was not available to be interviewed, due to current medical status. S1 was not able to answer LPA's questions, as that is beyond their work duties. Seven (7) out of Eight (8) staff (S2-S8), Three (3) out of three (3) residents (R1-R3) and one (1) witness (W1) interviewed have denied the allegation has taken place. S8 notified LPA that if a fall is unwitnessed, staff are not to relocate a resident without the assistance of a skilled medical professional. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been zero (0) deficiencies cited during today's visit.
An exit interview was conducted with Vanita Harris, Business Office Manager (S1), and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2