197610403-4-6-2025-31-AS-NMAN-DGA246-20250501170323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 04/06/2025
Date Signed: 04/06/2025 03:13:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/21/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240621110324

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: 107	DATE:	04/06/2025
		UNANNOUNCED	TIME BEGAN:	10:41 AM
MET WITH:	Ubaldo Guerrero		TIME COMPLETED:	03:28 PM

ALLEGATION(S):

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Due to neglect residents contracted a viral infection.
Resident received hospice services without consent.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent visit for the above noted allegations. LPA met with Ubaldo Guerrero and explained the reason for the visit.

---Due to neglect residents contracted a viral infection.

It was alleged that due to neglect, residents Resident #1 (R1) and Resident #2 (R2) contracted a Rhino infection at the Garden of Palms facility. To investigate the allegation, on 06/28/2024, LPA Tihesha Smith requested documents and interviewed two (02) staff from 11:00a.m. to 1:20 p.m. On 04/06/2025, LPA Duguma interviewed eleven (11) residents. According to interviews with two (02) staff members, R1 and R2 had limited interaction with the facility community, as they primarily remained in their rooms and opted for in-room dining.
(CONT on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2025

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-20240621110324

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDEN OF PALMS LA	FACILITY NUMBER: 197610403
	VISIT DATE: 04/06/2025

NARRATIVE

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Both staff members stated that they had not contracted any infection at the facility and were unaware of any resident or staff member being diagnosed with a Rhino viral infection between April and June 2024. An interview with the facility administrator on June 28, 2024, confirmed that no known cases of Rhino viral infections had been reported among residents or staff from January 2024 to June 2024. The administrator stated that the facility follows regular cleaning protocols and adheres to established health and safety guidelines. Additionally, the administrator confirmed that the facility has a current infection control plan in place. LPA review of the Department’s did not show that a viral outbreak was reported during the time in question and that facility does have an infection control plan in place. During interviews with residents, all residents stated they are not aware of any viral infection or outbreak during the time in question.

Based on interviews and records review there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

---Resident received hospice services without consent.

It was alleged that facility enrolled R1 to receive hospice services without their consent. To investigate the allegation, on 06/28/2024, LPA Tihesha Smith requested documents and interviewed two (02) staff from 11:00a.m. to 1:20p.m. A review of the R1’s hospice documents revealed that resident consented to hospice services. During interviews with staff, all staff stated resident was not coerced in any way by any staff and that those decision are made between the resident or resident’s responsible party and the resident’s physician or other medical professional.

Based on interviews and records review there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted at the time of this visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2025

LIC9099 (FAS) - (06/04)

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