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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:34:47 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
08/21/2024 and conducted by Evaluator Raymond Comer
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240821100726
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: DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Solange NkafuTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility Signal System is not consistently functional-
INVESTIGATION FINDINGS:
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On Thursday, 9/19/24, Licensing Program Analyst, (LPA) Raymond Comer, made a subsequent visit to continue a complaint investigation. The initial complaint visit was conducted on 08/29/24. LPA met with facility Wellness Director, Solange Nkafu, and the purpose of the visit was disclosed.

Allegation: Facility Signal System is not consistently functional- RP states the Resident 1's (R1's) service call system does not work consistently, that the system does not confirm if call was responded to, and that it takes staff 25 minutes minimum for staff to respond.

LPA conducted a physical plant tour at 10:10 AM; No Health/Safety issues were observed. LPA requested copies of facility documents relevant to the investigation at 11:05 AM (Resident Files, LIC500) and interviewed Staff from 11:15 AM, to 12:30 PM.

[LIC 9099C Continued]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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-20240821100726
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: 09/19/2024
NARRATIVE
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LPA assessed the Reporting Party's (RP) allegation with investigation of the following:
LPA visited R1's room, and activated the call service button. Within two minutes of activation, a facility caregiver Staff entered the room to response to the service call.

R1's call service button was activated while LPA observed the facility service call system network, which is located in the front office reception area. Once activated, R1's room number displayed on the system's monitoring screen, and a caregiver staff was promptly notified. Within two minutes of the activation of R1's service call, caregiver alerted receptionist staff that R1's service call was answered.

LPA interview with Staff (S1) stated that all Medication Technicians and Caregivers are notified, via work pager, of service calls activated by residents. Resident interviews with six (6) out of seven (7) residents state that resident service calls are answered and responded to in a timely manner.

Based on observation, and interviews, This allegation is unsubstantiated.

Exit interview was conducted, appeal rights discussed, and a copy of the report was given to the Administrator.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3