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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:27:10 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.ASC, 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
02/23/2024 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20240223154316
FACILITY NAME:GARDEN OF PALMS LAFACILITY NUMBER:
197610403
ADMINISTRATOR:HIRSCH,RENAFACILITY TYPE:
740
ADDRESS:1025 N FAIRFAX AVETELEPHONE:
(323) 656-7900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:130CENSUS: 107DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Adam Syncheff - Executive DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Due to insufficient staffing the food served to the residents gets cold.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Gary Tan and Liezel Dela Cerra conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPAs met with Executive Director Adam Syncheff and explained the reason for the visit.

LPA conducted physical plant tour at 10:00 AM, requested copies of facility documents at 10:24 AM and interviewed staff and resident between 11:00 AM to 1:00 PM. Regarding the allegation that due there is insufficient staffing the food served to the residents get cold. LPAs' record review at 12:32 PM revealed that there are three (3) servers scheduled at every meal. LPAs' interview with the Executive Director at 11:00 AM confirmed that there are always two (2) servers during meals and the dishwasher also acts as a server during meals. Further, about thirty (35) residents out of the current census are on Memory Care unit and had their caregivers and activity staff act as servers with average of four (4) servers every meal on their own. Moreover, about fifteen (15) residents from Assisted Living are being served trays every meal, leaving about fifty (50) to fifty (55) five residents are being served every meal on the dining area.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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 31-AS-20240223154316
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDEN OF PALMS LA
FACILITY NUMBER: 197610403
VISIT DATE: 02/27/2024
NARRATIVE
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(continued from LIC 9099)

LPAs observed that there are three (3) servers serving food during today's lunch at 12:15 PM. LPAs' interview with eleven (11) residents today between 11:00 AM to 1:00 PM revealed that nine (9) out of eleven (11) residents stated that the food was served to them on time or within five (5) minutes upon seating.

Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3