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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 02:56:26 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: 105DATE:
09/19/2024
UNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Solange Nkafu - Wellness DirectorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Residents concerns are ignored in the facility
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Gary Tan and Angelica Segovia conducted an unannounced subsequent visit at this facility to further investigate the above allegation. LPAs met with the Wellness Director Solange Nkafu and explained the reason for the visit.

LPAs conducted physical plant tour 9:30 AM, requested copies of facility documents relevant to the investigation at 10:34 AM and conducted interview with staff and residents between 10:45 AM to 1:00 PM. It was alleged that staff often ignore residents who request additional service such as soup or coffee, etc. and ignored their request and just turn around away from them. LPAs interview with eleven (11) residents today or more than 10% of the current census revealed that ten (10) out of eleven residents interviewed believed that they get what they ask in a timely manner and not being ignored by the staff. One (1) out of eleven (11) residents refused to be interviewed.


(continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
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 2
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: 09/19/2024
NARRATIVE
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(continued from LIC 9099)

LPAs also observed during lunch at around 12:36 PM that there are four (4) staff serving residents and all the meals were given on time and all the requests of the residents eating were accommodated when appropriate.

Based on the information gathered during this and prior 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: 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 2