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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801995
Report Date: 10/14/2020
Date Signed: 10/14/2020 03:38:06 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/28/2020 and conducted by Evaluator Joann Rosales
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20200428104743
FACILITY NAME:ALEXANDER GARDENSFACILITY NUMBER:
425801995
ADMINISTRATOR:LEICHTER, MITCHELLFACILITY TYPE:
740
ADDRESS:2120 SANTA BARBARA STTELEPHONE:
(805) 682-9644
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY:36CENSUS: 26DATE:
10/14/2020
UNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Mitchell LeichterTIME COMPLETED:
11:18 AM
ALLEGATION(S):
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Staff did not maintain a comfortable room temperature for resident #1 (R1)
INVESTIGATION FINDINGS:
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Due to the situation surrounding COVID-19 and to implement mitigation measures, Licensing Program Analyst (LPA) JoAnn Rosales conducted a complaint visit telephonically with Administrator, Mitchell Leichter.

Concerns were that the facility did not maintain a comfortable room temperature for resident #1 (R1) on 4/24/2020. Interview with R1 on 5/5/2020 at 1:43 pm revealed that on 4/24/2020 it was hot in their room on 4/24/2020 hot enough to make them sweat. R1 also indicated that they did not have a fan or an air conditioner in their room. Interview with Emergency Medical Technician (EMT) #1 on 5/7/2020 at 1:40 pm revealed that R1’s room was at least 85 to 90 degrees and they documented that it was a hot environment in R1’s room that day. Interview EMT #2 on 5/12/2020 at 1:12 pm revealed that they observed it being really hot in R1’s room on 4/24/2020. A review of R1’s medical records on 7/14/2020 at 1:18 pm revealed that R1’s temperature taken by the EMT’s on 4/24/2020 at 21:23:49 was 100.4 degrees F. R1’s temperature when first

Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020
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 29-AS-20200428104743
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ALEXANDER GARDENS
FACILITY NUMBER: 425801995
VISIT DATE: 10/14/2020
NARRATIVE
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taken in the emergency room on 4/24/2020 at 22:02 was 97.4 degrees F. R1 was not documented to have a fever while in the emergency room and during their in hospital stay. Based on the information obtained during the course of the investigation the complaint allegation is deemed substantiated at this time.

A telephonic exit interview completed, and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 29-AS-20200428104743
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALEXANDER GARDENS
FACILITY NUMBER: 425801995
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2020
Section Cited
HSC
1569.269(a)(5)
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1569.269 Enumerated rights; severability (a)(5)To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment.


This requirement is not met as evidenced by:
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Administrator stated that he will provide documentation of staff training regarding maintaining comfortable temperatures in residents rooms.
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Based on interviews and record review, the licensee did not comply with the section cited above as R1 was not provided a comfortable room temperature which posed a potential health and personal rights 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: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3