191805246-11-22-2022-31-AS-NMAN-CLWQB7-20221208110102

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191805246
Report Date: 11/22/2022
Date Signed: 11/22/2022 03:55:20 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
09/12/2022 and conducted by Evaluator Tihesha Smith

COMPLAINT CONTROL NUMBER: 31-AS-20220912103509

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: 60	DATE:	11/22/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Edgar Ramirezl		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff sexually assaulted resident in care.
Staff harassed resident(s) in care.
Staff spoke inappropriately to resident(s) in care.
Staff threatened resident(s) in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tihesha Smith made an unannounced complaint visit to this facility at 10:10 am to deliver findings. LPA Smith met with Edgar Ramirez and Galina Samuel and disclosed the purpose of this visit.
Licensing Program Analyst (LPA) Tihesha “Lynn” Smith made a subsequent complaint visit to this facility on 09/20/2022. LPA conducted interviews with clients from approximately 10:55 am to 11:40 AM and staff interviews from approximately 11:25-11:55 am and requested pertinent documents relevant to the investigation.
During initial visit, on 9/13/2022, LPA Smith conducted tour of physical plant at 11:18 am, conducted interviews with administrators and requested documents relevant to the investigation between 11:45-12:40 pm.

Regarding the allegation: Staff sexually assaulted resident in care.
It was alleged that Staff #1 (S1) engaged in sexual acts with Resident #2 (R2). To investigate the allegation, LPA interviewed staff, residents, and requested documents relevant to the investigation. .

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

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 3

Control Number 31-AS-20220912103509

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: BEL AIR GUEST HOME	FACILITY NUMBER: 191805246
	VISIT DATE: 11/22/2022

NARRATIVE

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(Cont from 9099)
LPA interview with Staff #2 (S2) revealed that Resident #2 (R2) often wanders in and out of the facility and both Resident #1(R1) and R2 are often away from the facility with whereabouts unknown during the day and night. During the initial visit and subsequent visits to this facility LPA observed that both R1 and R2 were not available for interviews as both residents where not present in the facility.
LPA Smith interview with S1 revealed they have not engaged in any sexual acts with R2 or with any resident residing at the facility. S1 revealed relationship with R2 friendly and provides any assistance to R2 when requested. S1 and S2 revealed R1 has refused medications, including missing medical appointment and/or not providing doctor contact information to allow staff to follow up with medical providers. S2 revealed R1 exhibiting behaviors due to not consistently taking prescribed medications. LPA interview with Resident #10 (R10) revealed that R1 had outbursts and threatened to kill them and others. LPA Smith’s review of physician report needs and services plan, centrally stored medications report/log indicate R1 has not received required daily dosage of medications.

Based on the interviews and information gathered during this and previous licensing visits there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation of: Staff harassed resident(s) in care.

It was alleged that staff harassed resident(s) in care. LPA interview with seven (7) out of sixty (60) residents revealed. (R1) and (R2) were not at the facility during the visits to be interviewed. LPA interviewed Resident #3 (R3) revealed that staff has not harassed them, and they have not witnessed any staff harassing any residents at this facility. Resident #4(R4) revealed they have not been harassed and have not witnessed any staff harassing residents. Resident #5 (R5) and Resident #6 (R6) also revealed they have not been harassed and have not witnessed any staff harassing residents. R4 revealed that Bel Air staff especially both administrators are helpful and kind. R5 stated they are comfortable speaking with both administrators.

LPA Smith interview with Staff #(S3) revealed that they have not harassed any residents and has not witnessed any staff harassing any residents. Staff #4 (S4) also revealed has not harassed and has not witnessed any staff harassing any residents.

(Cont to 9099C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20220912103509

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: BEL AIR GUEST HOME	FACILITY NUMBER: 191805246
	VISIT DATE: 11/22/2022

NARRATIVE

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Cont from 9099C)
Based on the interviews there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
Staff spoke inappropriately to resident(s) in care
It was alleged that staff spoke inappropriately to resident(s) in care. LPA interview with seven (7) out of sixty (60) residents revealed that staff working throughout the facility speak kindly to residents when greeting and conversing with residents. LPA interview with R3 revealed that staff has not spoken to them inappropriately. Interview with R4 also revealed that staff has not spoken to them inappropriately and they have not witnessed any staff speaking inappropriately to any residents. R5 and R4 revealed that some discussions may require a firm response but never anything disrespectful or inappropriate.
LPA Smith interview with S3 revealed that they have not spoken inappropriately to any residents and has not witnessed any staff speaking inappropriately to residents.

Based on interviews there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Staff threatened resident(s) in care
It was alleged that staff threatened resident(s) in care. LPA interview with seven (7) out of sixty (60) residents revealed that staff and residents have mutual respect for all individuals living and those working at the facility. LPA interview with Resident #7(R7) revealed that staff has not threatened them. Interview with resident #8 (R8) also revealed that staff has not threatened them and has not witnessed any staff threatening any residents. R7 revealed that both administrators are easy to talk to and they make you feel comfortable and confident that they will do their best to help resolve any issue that you have.

S1 revealed enjoys talking with residents and both residents and staff and does not have any issues with anyone at the facility. S2 revealed community of staff and residents are friendly and has not threatened or witnessed any staff threatening residents. S3 and S4 also revealed has not witnessed any staff threatening any residents.

Based on interviews there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted /Copy of report given.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022

LIC9099 (FAS) - (06/04)

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