197602370-6-25-2021-11-AS-MVAO-C4WL69-20210714082821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602370
Report Date: 06/24/2021
Date Signed: 06/25/2021 11:21:22 AM

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
03/29/2021 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210329155149

FACILITY NAME:	BEVERLY HILLS CARMEL RETIREMENT HOTEL NORTH		FACILITY NUMBER:	197602370
ADMINISTRATOR:	ARIELLA BENBASSAT		FACILITY TYPE:	740
ADDRESS:	8757 BURTON WAY		TELEPHONE:	(310) 278-8323
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	138	CENSUS: 40	DATE:	06/24/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ariella Benbassat, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident's are not served nutritious meals.
Resident's rooms are not cleaned
Staff not providing adequate laundry services
Staff withheld food from resident's.

INVESTIGATION FINDINGS:

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

The investigation consisted of following: Interviews and Record reviews. On 04/07/21, LPA Soto
conducted telephone interview with the Administrator Ariella Benbassat. On 06/08/21, LPA Soto
conducted interviews with S#2 - S#7, R#1 - R#5. LPA toured rooms 301,305, 208, 207, 416, checked
bathrooms and bedding in each of the rooms. Kitchen and (refrigerators,) Laundry room, Dining room,
Med room 2nd floor, Housekeeping carts for Floors 2nd, 3rd, & 4th. The carts were full of linens, towels,
and cleaning solutions, linen closet for 3rd Floor was full of clean bedding, beauty salon,1st Floor
restroom, and activity room. LPA also observed residents having lunch and eating their meals in the
dining room and in their private rooms. LPA Soto also requested copies of the following documents:
Resident and Staff rosters, housekeeping schedule, duty schedule, menu, and laundry schedule.

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)

Page: 1 of 3

Control Number 11-AS-20210329155149

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 NORTH	FACILITY NUMBER: 197602370
	VISIT DATE: 06/24/2021

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following. For Allegation #1 - Residents
are not served nutritious meals. Interviews with the administrator and S#2 – S#7, they stated that the
meals served are nutritious. They are balanced meals. Interviews with R#1 – R#7, they stated that the
food is okay, but they food could be better. They serve food that they request is it’s not on the menu,
they still make the food for them. LPA Soto reviewed the facility menu and observed residents eating
their lunch. The food that was served was nutritional. The residents had chicken and fresh vegetables for
lunch. The interviews and records reviewed did not concur with the above allegation.

Allegation #2 - Resident's rooms are not cleaned. Interviews with the administrator and S#2 – S#7, they
stated that all the facility is clean. They clean all the facility daily. The rooms are cleaned daily but deep
cleaning is done once a week. Housekeeper’s clean bathroom and rooms daily, but they vacuum, dust,
and change beddings once a week. Interviews with R#1 - R#7, stated that their rooms and the facility are
always clean. The staff is good at cleaning everything. LPA Soto reviewed the housekeeping schedule
and duty schedule; they facility has enough staff that cleans the facility. LPA Soto toured some common
areas and certain rooms within the facility, the common areas (restrooms, library, activity room) and 2nd
and 3rd floors rooms were clean and upright. The interviews and records reviewed did not concur with
the above allegation.

Allegation #3 - Staff not providing adequate laundry services. Interviews with the administrator and S#2
– S#7, they stated that they wash the beddings and towels every day. They wash the resident’s laundry
once a week. Interviews with R#1 - R#7, stated that they always have clean bedding and clean towels
every day. Their personal clothes are washed once a week. LPA Soto reviewed the laundry schedule and
it showed that they have staff wash linens and towels every day and resident’s personal clothes once a
week. The interviews and records reviewed did not concur with the above allegation.

Allegation #4 - Staff withheld food from residents. Interviews with the administrator and S#2 – S#7, they
stated that no staff has ever with held food from any resident. Interviews with R#1 - R#7, stated that
they have never had any staff withheld any food from them. They always get all three meals a day. The
interviews conducted did not concur with the above allegation.

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)

Page: 2 of 3

Control Number 11-AS-20210329155149

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 NORTH	FACILITY NUMBER: 197602370
	VISIT DATE: 06/24/2021

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	Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted with Ariella Benbassat, 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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