<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610403
Report Date: 06/17/2025
Date Signed: 06/17/2025 01:13:44 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
11/13/2024 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20241113154930
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:
06/17/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adam Syncheff- Executive DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not properly transferring resident to their wheelchair resulting in injury
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/17/2025 at approximately 10:00 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation(s). LPA was greeted by the Executive Director (ED), Adam Syncheff and stated the reason for their visit was to gather information, conduct interviews and deliver findings for this complaint.

To investigate the allegation(s) at 10:15 AM, LPA requested census, resident, and staff roster. At approximately 10:30 AM, LPA requested pertinent documents pertaining to the investigation such as but not limited to: Medication, Staff Training and Staff schedule. At 11:30 AM LPA conducted a physical plant tour, to ensure the health and safety of the residents. Between 10:30 AM – 1:00 PM, LPA attempted interviews with four (4) staff members (S1-S4) and one (1) resident (R1).

(continue to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
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-20241113154930
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: 06/17/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation: Facility staff are not properly transferring resident to their wheelchair resulting in injury. It was alleged that R1 fell while being transferred to their wheelchair resulting in injuries. To investigate the allegation, LPA interviewed four (4) staff members. Interview with S3 revealed that while R1 was being assisted within the shower area, R1 began to slide down from their chair. S3 stated the facility self reported the incident on an Unusual Incident/Injury Report (SIR) and noted that R1 was assisted, “…to the floor in a controlled manner”. LPA’s interview with S4 revealed that R1 was checked for any injuries which they noted, R1 did not complain of any pain and/or showcased any signs of injuries. S4 stated that R1 was safely transferred back to their chair with assistance by S2 where no further incident occurred. LPA attempted to interview S2, but S2 no longer works at the facility and could not be contacted. LPA’s record review confirmed that the facility did report the incident to the appropriate reporting parties including Community Care Licensing Division (CCLD). Further record review of staff observational notes of R1 for the remainder of the date of occurrence showcased that R1 was observed to be in good health and complained of no pain. Additional record review revealed that R1 has various medical diagnosis, which can contribute to the weaking of the skin resulting in self-bruising. During LPA’s physical tour, LPA observed R1 to appear to be in good health and participating in activities with their peers. LPA attempted to interview R1 but R1 was participating in group activities, LPA terminated the interview.

Furthermore, based on LPA’s interviews, record review and observations there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety issues observed during the day of the visit. Exit interview conducted and a copy of this report was provided to the Executive Director.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2