191805246-12-21-2021-31-AS-DPEA-CB4VMA-20220128153314

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191805246
Report Date: 12/21/2021
Date Signed: 12/21/2021 03:41:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/27/2020 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 31-AS-20200127094237

FACILITY NAME:	BEL AIR GUEST HOME		FACILITY NUMBER:	191805246
ADMINISTRATOR:	SAMUEL, GALINA		FACILITY TYPE:	735
ADDRESS:	1440 NO. STANLEY AVENUE		TELEPHONE:	(323) 876-3370
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	64	CENSUS: 58	DATE:	12/21/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Galina Samuel		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff handled client(s) in a rough manner
Facility staff yelled at client(s) in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi initiated a subsequent complaint investigation for the allegations listed above. Upon arrival LPA was met by facility Administrator Galina Samuel and explained the reason for the visit.
During the investigation, LPA conducted physical plant on 01/31/2020, as well as interviewed interview Administrator and residents. LPA also reviewed and obtained copies of pertinent documents relevant to the investigation. Today LPA conducted physical plant, interviewed staff and residents.

It was alleged that facility staff handled client(s) in a rough manner and Facility staff yelled at client(s) in care, LPA interview with (12) residents revealed that each resident has neither witnessed or experienced staff handle residents in a rough manner or yell at other residents. LPA interview with staff further revealed that each staff member has neither witnessed or experienced any staff handle resident in a rough manner or yell at other residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

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-20200127094237

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: BEL AIR GUEST HOME	FACILITY NUMBER: 191805246
	VISIT DATE: 12/21/2021

NARRATIVE

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(Continued from 9099)

LPA interviews with parties with knowledge of Resident 1 (R1) and the facility did not provide enough evidence to substantiate allegations. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility staff handled client(s) in a rough manner and that facility staff yelled at client(s) in care. Therefore, the above allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted with Administrator, and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

LIC9099 (FAS) - (06/04)

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