197602106-6-24-2021-11-AS-MVAO-C4VW44-20210713165654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602106
Report Date: 06/24/2021
Date Signed: 06/24/2021 12:46:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2021 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210325114619

FACILITY NAME:	BEVERLY HILLS CARMEL RETIREMENT HOTEL		FACILITY NUMBER:	197602106
ADMINISTRATOR:	JOY ALVARADO		FACILITY TYPE:	740
ADDRESS:	8750 BURTON WAY		TELEPHONE:	(310) 278-9720
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	200	CENSUS: 51	DATE:	06/24/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Bernice Pulanco, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility does not provide a safe environment for residents.
Facility does not have night supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with, the facility administrator.

The investigation consisted of following: Interviews and Record reviews. On 03/31/21, LPA Soto interviewed former administrator Joy Alvarado. On 06/11/21 LPA Soto interviewed new administrator Bernice Pulanco, S#3 - S#4, R#1 - R#5. On 06/24/21, LPA interviewed witness #1. LPA toured rooms 106, 221, 223, 301, & 306, lobby, dining room 1st floor restroom, 3nd floor library, 1st floor activity room. The LPA also requested copies of the following documents: Resident and staff roster, Front desk schedule, Med aide schedule, Care staff schedule, Physician's Report, needs and services plan, and Incident Reports for (April, May, June 2021.)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021

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 11-AS-20210325114619

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS CARMEL RETIREMENT HOTEL	FACILITY NUMBER: 197602106
	VISIT DATE: 06/24/2021

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following. For Allegation #1 – Facility does not provide a safe environment for residents. Interviews conducted with both administrators, S#3 – S#4, stated that there is 1 resident that always screams and yells. R#1 has a mental disorder, where R#1 experiences episodes of paranoia and anxiety. In which causes R#1 to yell and scream at all hours of the day and night. R#1’s room is on the side where there’s an apartment building next to it, where the neighbors might be able to hear R#1’s screams and yells. The facility is aware of the R#1’s condition and has a plan on how to help R#1 and are givers follow the care plan. Interviews with R#1 – R#5, were unable to answer questions for LPA Soto. LPA Soto reviewed records for R#1 and records showed that R#1 does have a mental condition that causes R#1 to scream and yell, but not because R#1 is in distress. Interviews conducted and records reviewed did not concur with the above allegation.

Allegation #2 - Facility does not have night supervision. Interviews conducted with both administrators, S#3 – S#4, stated that there is night supervision. There is 1 care giver, 1 Med aide, and 1 supervisor for the night shift. There is also someone at the front desk 24 hours a day 7 days a week. Interviews with R#1 – R#5 did not know about any night supervision. LPA Soto reviewed the staff schedule, front desk schedule, and med aide schedule. There is enough night supervision for the facility. The interviews conducted and records reviewed do not concur with the above allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated

A exit interview was conducted with Bernice Pulanco, Administrator, and a hard copy was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021

LIC9099 (FAS) - (06/04)

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