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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 10/31/2024
Date Signed: 10/31/2024 02:52:01 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
10/30/2024 and conducted by Evaluator Raymond Comer
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20241030142514
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:
10/31/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Adam SyncheffTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff left resident soiled in urine resulting in a rash-
Call button not accessible to resident-

INVESTIGATION FINDINGS:
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On Thursday, 10/31/2024, at 09:35 am, Licensing Program Analyst, (LPA) Raymond Comer, arrived to the Facility to initiate the10-day complaint investigating the above allegation(s). LPA was met by the Administrator, Adam Syncheff, and reason for the visit was discussed.

At 9:45 am, LPA conducted a physical plant tour of the facility; No health and safety issues were observed.

Allegation: Staff left resident soiled in urine, resulting in a rash- Reporting Party (RP) states Staff is not providing R1 timely care regarding diaper changing.

To investigate the complaint. LPA conducted a records review, observation, interviewing resident, and staff.

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

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
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-20241030142514
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: 10/31/2024
NARRATIVE
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From 10:00am to 11:30am, LPA interviewed the Administrator, and staff. Interviewed Staff deny the allegation, stating that R1 is checked on a minimum of two-hour intervals to insure they are made comfortable, clean, and dry. Both the Administrator, and Staff#1 (S1) recently conducted a "care conference" to discuss and optimize R1's level of care. The results of Staff conference objectives were communicated to R1's responsible family member. A review of documents by LPA revealed Staff's agreement to provide enhanced care, due to R1's frequent incontinence needs. Staff state they encourage R1 to go to the bathroom every couple of hours, and communicate with R1's responsible family member when R1 refuses caregiver assistance. LPA observed R1 in their bedroom, sleeping in a chair recliner. At the time of LPA's observation, R1 appeared as well groomed, clean, with no trace of urine smell.

Based on the information obtained, there was insufficient evidence to prove that R1 is left soiled for an extended period of time. Therefore, the allegation is deemed Unsubstantiated at this time.

Allegation: Call button not accessible to resident- RP states that R1 must wait 20 to 40 minutes, or longer, for a caregiver to respond to the call.

To investigate this complaint, LPA conducted interviews with staff, residents and facility observation. Five (5) out of five (5) residents states that caregivers respond to service calls at a reasonable time. LPA conducted an observation of R1's room, pressing the service call button; staff responded within three minutes of its activation. Based on the information gathered during this, and prior visits, this allegation is deemed Unsubstantiated at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2