197610403-1-28-2025-31-AS-NMAN-DPLMZ2-20251222090224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 01/28/2025
Date Signed: 01/28/2025 07:53:29 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
01/22/2025 and conducted by Evaluator Raymond Comer

COMPLAINT CONTROL NUMBER: 31-AS-20250122094309

FACILITY NAME:	GARDEN OF PALMS LA		FACILITY NUMBER:	197610403
ADMINISTRATOR:	HIRSCH,RENA		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	130	CENSUS: 104	DATE:	01/28/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Adam Syncheff		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility Staff failed to inform resident's representatives of medical services provided, and health status updates of resident while in care-

INVESTIGATION FINDINGS:

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On Tuesday, 1/28/25, at 9:00 am, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct a subsequent visit regarding the allegation listed above. LPA conducted the initial complaint visit on 1/27/25. LPA met with facility Administrator, Adam Syncheff, presented official CDSS badge identification, and reason for the visit was disclosed.

At 9:15 am, A physical plant tour of the facility was conducted by LPA; No health or safety issues observed.

Allegation: Licensee failed to inform Resident#1's (R1's) representative of provided wound care services and notification that R1 was transferred out of the facility and transported to Hospital for health assessment.

To investigate the allegation, LPA received Facility resident roster, and staff roster.
[LIC 9099C Continued]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250122094309

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: 01/28/2025

NARRATIVE

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At 9:25 am, LPA reviewed Resident 1's (R1) file, and other documents relevant to the investigation. Between 10:15 am and 12:30 pm, LPA conducted on-site interviews with Administrator, Staff, and six (6) responsible family members of facility residents.

The Reporting Party (RP) alleges that staff failed to provide health status notifications regarding wound care services provided to R1. Additionally, the RP states facility staff did not attempt to notify the responsible family member that, in the month of December 2024, R1 had been transferred out of the facility, and transported to Hospital to diagnose the possibility of a stroke.

LPA conducted a review of R1's file, and relevant documentation, finding the following: Prior to R1's September 2024 admission into the facility, R1 was identified as having a foot wound requiring medical care. R1's file contains documentation confirming that wound care service assistance was initiated in the same month of R1's admission, and continues to the current date. Facility Administrator provided LPA phone texts communicating to R1's responsible family member (F1) the status of R1's wound care assistance.

LPA interview with F1 revealed the following: F1 confirmed to LPA that the Administrator did provide them notification that wound care services were being provided by Agency, Skilled Home Health, and that R1's wound is currently "dry and healing."

LPA interview with the Administrator and Staff revealed the following: Both Administrator, and Staff refute this allegation, stating that facility medical staff informed F1 regarding status updates of R1's wound care, and notification of R1's transfer and hospitalization.

LPA interview with six (6) responsible family members of residents revealed the following: Six (6) out of six (6) responsible family members state that facility staff consistently report activities related to resident care and services.

Based on LPA documents, interviews with staff, and responsible family members of residents, The allegation is deemed UNSUBSTANTIATED at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC9099 (FAS) - (06/04)

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