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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 09/18/2024
Date Signed: 09/18/2024 04:10:03 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
09/26/2023 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230926094138
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: 104DATE:
09/18/2024
UNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Administrator, Adam SyncheffTIME COMPLETED:
04:20 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff do not assist residents with ambulation
Staff do not provide residents with a sufficient amount of living accommodations
Staff do not serve residents with food of good quality
INVESTIGATION FINDINGS:
1
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3
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7
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10
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13
At 10:15am Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted unannounced complaint visit to the facility to complete investigation of the above noted allegations and to deliver final report. At 10:30am LPA met with the Administrator, Adam Syncheff.

To investigate the above noted allegations, during initial visit conducted on 09/26/23, LPA Gina Saucedo requested copies of personnel report, resident roster and conducted a physical plant tour at 1:30pm. During subsequent visit conducted on 08/09/24, at 10:30am LPA Alvizar-Ettima and Wellness Assistant, Karla Garcia conducted a physical plant tour. At approximately 2:15pm, LPA requested and obtained copies of facility documents including but not limited to staff and resident roster.

At the time of visit at approximately 10:30am LPA and Wellness Director, Solange Nkafu toured the physical plant and between 11:00am -1:30pm LPA spoke with Administrator, Staff (S#1 -S#2), and Residents (R#1 -R#10). LPA Alvizar asked questions relevant to the nature of the complaint.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
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 4
Control Number 31-AS-20230926094138
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 OF PALMS LA
FACILITY NUMBER: 197610403
VISIT DATE: 09/18/2024
NARRATIVE
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1.) Staff do not assist residents with ambulation

It is alleged that resident (R1) along with other residents ambulating in wheelchairs, constantly cry for staff to help them push their wheelchairs into the TV room. Staff interviews reveal that they are always assist residents with ambulation from the diner to the TV room or anywhere else resident's want to go in the facility. LPA interview ten (10) out of one hundred – four (104) residents requiring ambulation assistance including R1. R1 and other residents indicated that staff are always assisting them, and they did not have any concerns about the allegation. R1 indicated that they refuse staff assistance because they are strong and prefer to push themselves. Administrator and staff revealed that residents are always assisted with their ambulation needs. R1 sometimes refuses to be wheel and prefers to self propel around the facility to maintain their independence. During investigation, LPA did not observe residents crying for staff assistance.

Prior to this visit LPA Alvizar-Ettima reviewed facility records including Care Staff Assignments. The information revealed from records supported the information provided by the facility personnel. According to record review R1 uses a wheelchair and needs minimum staff assistance.



Based on interviews, observation and record review, there is no pertinent information to support the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

2.) Staff do not provide residents with a sufficient amount of living accommodations

It is alleged that there aren’t enough chairs available for all of the residents in care, resulting in residents constantly fighting over chairs. During prior inspections visits Licensing Program Analyst (LPA’s) Saucedo and Alvizar-Ettima conducted physical plan tour and observed sufficient number of chairs and did not witnessed residents fighting over chairs. Residents interviewed during this investigation revealed that the facility always has sufficient amount of chairs for everyone. Administrator and staff indicated that there are sufficient chairs in the facility. During today’s visit LPA Alvizar-Ettima observed sufficient number of chairs and did not witnessed residents fighting over chairs.

Based on interviews and observation, there is no pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20230926094138
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 OF PALMS LA
FACILITY NUMBER: 197610403
VISIT DATE: 09/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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21
22
23
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27
28
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32
3.) Staff do not serve residents with food of good quality

It is alleged that staff watered down the orange and apple juices. R3 is used to drinking freshly squeezed orange juice.

During the time of this investigation R3 no longer resides at the facility therefore, LPA Alvizar-Ettima was not able to interview them. Interview with ten (10) out of one hundred and four (104) residents revealed that the orange & apple juices are not watered down and had no concerns about the food quality. Staff indicated that the juice is not watered down for residents. Resident’s that are on a special diet are provided a sugar free juice. During inspection LPA Alvizar-Ettima did not observed watered down juice.

Based on interviews and observation, there is no pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.



No health and safety hazard is noted during this visit.



Exit interview is conducted and copy of report was provided to Administrator.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
09/26/2023 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230926094138

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: 104DATE:
09/18/2024
UNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Administrator, Adam SyncheffTIME COMPLETED:
04:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not assist resident with managing his behaviors
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Staff do not assist resident with managing behaviors
It is alleged that resident #2 (R2) disturbs resident #3 (R3). In addition, R2 yells and fights with other residents. Staff do not manage R2’s behavior and should be removed from the facility.

During the time of this investigation R3 no longer resides at the facility therefore, LPA Alvizar-Ettima was not able conduct an interview. Interview with Administrator and staff indicated that R2 was never a resident of the facility. Prior to this visit and also at the time of this visit, LPA Alvizar-Ettima reviewed facility records including resident and staff roster. A review of previous and current facility resident roster did not indicate that R2 is a former or current resident at this facility. The information revealed from records supported the information provided by the facility personnel. Therefore, based on interviews and record review this allegation is deemed Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.No health and safety hazard is noted during this visit.
Exit interview is conducted and copy of report was provided to Administrator.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4