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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 01/13/2025
Date Signed: 01/13/2025 02:12:54 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
07/23/2024 and conducted by Evaluator Raymond Comer
COMPLAINT CONTROL NUMBER: 31-AS-20240723125344
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:
01/13/2025
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Adam SyncheffTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility is not in compliance with approved Hospice Waiver-
INVESTIGATION FINDINGS:
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At 9:25 am, Monday, 1/13/25, Licensing Program Analyst (LPA) Raymond Comer, conducted a subsequent visit regarding the allegation listed above. LPA conducted the initial complaint visit on 7/30/24, and subsequent visit on Friday, 10/04/24. LPA met with Administrator Adam Syncheff, and the purpose of the visit was disclosed.

At 9:35 am, LPA conducted a physical plant tour; no health and safety issues were observed.

To investigate the allegation, LPA received Facility resident roster, and staff roster. At 9:40 am, reviewed Resident files, and other documents relevant to the investigation, and conducted on-site interview with the Administrator.

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

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
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-20240723125344
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: 01/13/2025
NARRATIVE
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The Reporting Party (RP) alleges that facility has failed to comply with title 22 regulations regarding the admission of residents receiving hospice care services.

LPA interview with the Administrator confirms their awareness and requirement to comply with Title 22 regulation regarding acceptance of terminally ill persons accepted by the facility as residents. LPA review of resident records revealed the following: Facility has four (4) residents receiving hospice care.
Records contain approved hospice waiver, required terminal diagnoses by a Physician, facility agreement to accept/retain terminally ill residents, and singed agreements of those residents sharing a room with co-residents receiving hospice care.

Based on interview, and record reviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2