198603220-8-3-2023-11-AS-MVAO-CVMR3H-20230913123958

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603220
Report Date: 08/03/2023
Date Signed: 08/03/2023 08:46:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/31/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230731145425

FACILITY NAME:	CITY VIEW LA, LLC		FACILITY NUMBER:	198603220
ADMINISTRATOR:	YONATAN ISAACS		FACILITY TYPE:	740
ADDRESS:	515 N LA BREA AVE		TELEPHONE:	(323) 938-2131
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90036
CAPACITY:	166	CENSUS: 73	DATE:	08/03/2023
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Mendy Ginsburg		TIME COMPLETED:	04:06 PM

ALLEGATION(S):

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Unlawful eviction.

INVESTIGATION FINDINGS:

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On 08/03/23 Licensing Program Analysts (LPAs) Ernand Dabuet and Ruby Velasco conducted an intial complaint visit at this facility. LPAs met with Executive Director Mendy Ginsburg. LPA Dabuet explained the purpose of the visit is to investigate the allegation mentioned above.

The investigation consisted of the following: Interview with staff #1-#3 (S1-S3), resident #1 (R1), and witness #1 (W1). A review of staff/resident rosters, service records for (R1) and other pertinent documents associated with this complaint. A tour of the facility was conducted.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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-20230731145425

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CITY VIEW LA, LLC	FACILITY NUMBER: 198603220
	VISIT DATE: 08/03/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Unlawful Eviction.

The details of the complaint alleged that resident #1 (R1) was evicted from the facility. The complainant reported that (R1) was not given a notice before the move and considered the action as an unlawful eviction.

The Department interviewed Executive Director staff #1 (S1). (S1) stated (R1) moved in on 03/23/23. (S1) was to occupy room #423 a private room. The current resident of #423 was still occupying the room, so the room was not available. (R1) was provided a “temporary room” #209 until the room #423 became vacant. Room #209 was a shared room and the facility accommodated (R1) and made it into a private room knowing it was only a temporary. Once room #423 became available, (R1) no longer desired the room and preferred maintaining in room #209, according to (S2).

(S2-S3) overheard (R1) was dissatisfied with other residents and stated that if unable to stay in room #209, (R1) will just leave the facility. (S1) claimed that (R1) was admitted into the facility with the assistance of (R1’s) case manager. (S1) reported that (R1) was not given an eviction notice as (R1) had voluntarily terminated residency to relocate in Evergreen Retirement Residence. (S1) stated that when (R1) had refused in taking room #423, (R1) was provided options of other facilities that had vacancies with private rooms. (S1) stated that options plans were discussed with (R1) before (R1's) hospitalization at Cedars Sinai on 07/15/23 – 07/18/23. In addition, since (R1) was discharged, there were no private rooms available, and due to (R1)'s) health condition, (R1) had to stay in a private room.

An interview with (R1) stated no prior discussion or options were implemented by management before (R1’s) hospitalization 07/15/-23 – 07/18/23. (R1) claimed that management wanted to place a new resident in room #209 was the reason for (R1's) move on 07/20/23. (R1) admitted signing the admissions agreement at Evergreen at Retirement Residence and knowingly what the content of the agreement.

After reviewing (R1's) service records, the Department determined that (R1) is independent, capable of self-care, and has not been diagnosed with a mental condition. (R1) has the full capacity to manage financial affairs. The Department conducted a tour of the facility and observed room #209 remains unoccupied. Based on gathered information, there is no evidence to support the allegation mentioned above.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230731145425

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CITY VIEW LA, LLC	FACILITY NUMBER: 198603220
	VISIT DATE: 08/03/2023

NARRATIVE

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Based on the information collected, an inspection of the facility, observation, record reviews, and interviews conducted, the Department found no evidence to support the allegation for this complaint.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted with Mendy Ginsberg, and copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

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