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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603601
Report Date: 08/12/2020
Date Signed: 08/17/2020 08:32:44 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:BEVERLY HILLS LOVING CAREFACILITY NUMBER:
197603601
ADMINISTRATOR:LIDA ZARAFSHANFACILITY TYPE:
740
ADDRESS:1019 S. WOOSTER STREETTELEPHONE:
(310) 652-3555
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:176CENSUS: 76DATE:
08/12/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ilana Yazdi, ManagerTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Ana Soto initiated a case management visit. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted via tele-visit with Ilana Yazdi, the facility manager.

LPA Soto conducted tele-visit interviews with the manager and 1 resident. On 08/06/20, It was reported that a resident's room had been burglarized and money had been the only item stolen. The incident occurred on 07/05/20, 911 was called and report had been made. The incident is still been investigated by detectives. The resident does not remember seeing anyone enter their room. The facility has not allowed visitors due to the Covid-19 pandemic, the manager stated that no one has come to visit the resident, nor do other residents go to the resident room. As far as the facility is concerned, they are letting the Police complete the investigation and wait on their results..

A telephonic exit interview was conducted with Ilana Yazdi, and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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