197608971-3-14-2025-31-AS-NGID-DFELLV-20250404085142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608971
Report Date: 03/14/2025
Date Signed: 03/14/2025 02:56:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/23/2024 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20240523141037

FACILITY NAME:	GARDEN GROVE VILLA		FACILITY NUMBER:	197608971
ADMINISTRATOR:	MORALES, NEIL M.		FACILITY TYPE:	740
ADDRESS:	8051 GARDEN GROVE AVENUE		TELEPHONE:	(818) 448-6852
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 6	DATE:	03/14/2025
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Neil Morales, Administrator		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Resident was severely dehydrated and malnurished while under care.
Staff do not ensure adaquet care and supervision is provided to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent visit to this facility to deliver the final report. LPA met with Staff Dellnia Morales and the Administrator Neil Morales was contacted via telephone. LPA explained the reason for the visit. Administrator arrived at the facility at 2:50 PM.
On 05/23/2024, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding allegations, “Resident was severely dehydrated and malnourished while under care, and staff do not ensure adequate care and supervision is provided to resident” The complaint was referred to Community Care Licensing Division’s Investigations Branch. The complaint was assigned to investigator Douglas Real.

On 05/24/2024 LPA Rahimi conducted an initial 24-hour complaint visit. At 09:45 AM, LPA requested resident and staff roster. At approximately 09:55 AM, LPA conducted a physical plant tour. At 10:10 AM, LPA requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan.
Continue on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025

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 31-AS-20240523141037

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDEN GROVE VILLA	FACILITY NUMBER: 197608971
	VISIT DATE: 03/14/2025

NARRATIVE

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Investigator Douglas Real conducted interviews with witnesses on 05/24/2024, Resident #1 (R1) family members on 08/06/2024, 08/26/2024, Administrator and facility staff on 06/20/2024, 07/02/2024, facility residents on 06/20/2024, and Hospital Medical Record was requested on 05/24/2024 and received on 06/05/2024.
Allegation: Resident was severely dehydrated and malnourished while under care.
The investigation findings revealed that R1 had been living at this facility since July, 2021 and was diagnosed with dementia and other health related issues. It was alleged that Resident #1 (R1) was hospitalized due to severe dehydration and malnutrition. Investigator conducted interview with the Administrator, and it was revealed that prior to the hospitalization, R1 became more confused than normal, and his/her food and water intake declined. Moreover, the facility staff was spending more time to encourage R1 to eat and drink. Additional interviews were conducted with three (3) staff members who also confirmed the above information. The facility staff notified R1’s responsible party and agreed to take R1 to the hospital for further evaluation. Interview with the POA of R1 also confirmed the information provided by both the Administrator and staff, and informed the investigator that the facility never withheld any food/water from R1. Furthermore, interviews with three (3) residents revealed that facility staff always provides enough food and water to all residents and never withheld any food or water. The investigator also reviewed Medical Records of R1 and did not observe any indication of malnutrition. Therefore, based on the information through interviews and review of hospital records that IB obtained, the above allegation is deemed Unsubstantiated at this time.
Allegation: Staff do not ensure adequate care and supervision is provided to resident.
It was alleged that the facility staff did not provide adequate care and supervision to R1 and found R1 without a diaper in his/her room. Investigator conducted an interview with the Power of Attorney (POA), and it was revealed that the facility always provided a good care to R1. The POA also informed the Investigator that the facility always keep in touch about any changes with R1’s condition in a timely manner. Furthermore, during the interview it was revealed that prior to R1’s hospitalization the facility staff found R1 without his/her diaper and informed the POA immediately. Facility staff provided a picture of R1 to inform the POA about R1’s condition. Subsequently, the POA shared the picture with another family member of R1 to inform them of R1’s condition. The other family member became upset and felt that R1’s situation was due to neglect and care. During the interview with the other family member of R1, the Investigator was informed that he/she visited R1 at the facility on weekly basis, and during all the visits he/she did not observe any neglect or abuse from the facility staff.
Continue on LIC 9099C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240523141037

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDEN GROVE VILLA	FACILITY NUMBER: 197608971
	VISIT DATE: 03/14/2025

NARRATIVE

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The other family member visited R1 on 05/12/2024 at the facility, and R1 did not report any lack of care and abuse from the facility staff. Interviews with the Administrator and staff also denied the allegation. Moreover, residents interviewed also did not have any concerns regarding the lack of care and supervision. Based on the investigator interviews this allegation is deemed Unsubstantiated at this time.
No deficiency cited.
Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025

LIC9099 (FAS) - (06/04)

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