197603601-2-19-2025-11-AS-SCIS-DEJATH-20250306233023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603601
Report Date: 02/19/2025
Date Signed: 02/19/2025 03:14:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/12/2025 and conducted by Evaluator Elvira Gonzalez

COMPLAINT CONTROL NUMBER: 11-AS-20250212122159

FACILITY NAME:	BEVERLY HILLS LOVING CARE		FACILITY NUMBER:	197603601
ADMINISTRATOR:	LIDA ZARAFSHAN		FACILITY TYPE:	740
ADDRESS:	1019 S. WOOSTER STREET		TELEPHONE:	(310) 652-3555
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	176	CENSUS: 82	DATE:	02/19/2025
		UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Lida Zarafshan		TIME COMPLETED:	03:32 PM

ALLEGATION(S):

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Staff did not keep facility free of bed bugs.

INVESTIGATION FINDINGS:

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On 02/19/25, the department conducted an unannounced complaint visit to investigate the above-mentioned allegation. The department met with Administrator, Lida Zarafshan, and the purpose of today’s visit was explained.

The investigation consisted of the following: The department requested, and received the following documents: staff roster, resident roster, and pest control records (dated: 11/09/24, 11/27/24, 12/09/24, 12/27/24, 01/09/25, and 01/30/25). The department interviewed staff #1-#6 and resident’s #1-#6 (R1-R6). Furthermore, the department conducted a tour of the entire facility and inspected rooms #103, #104, #109, #111, #115, and #121, #127, #201, #202, and #217.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

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-20250212122159

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BEVERLY HILLS LOVING CARE	FACILITY NUMBER: 197603601
	VISIT DATE: 02/19/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff did not keep facility free of bed bugs. It is being alleged that multiple residents have bed bug bites. Based on interviews conducted, 6 out of 6 staff interviewed denied the allegation. 6 out of 6 staff interviewed stated they have not observed any bed bugs in the facility. 6 out 6 staff interviewed stated that the resident’s rooms are cleaned daily and as needed. 6 out of 6 staff interviewed stated there is a pest control company that comes and provides services twice a month.

Based on interviews conducted, 6 out of 6 residents interviewed stated they have not observed any bed bugs, in their rooms or in the facility. 6 out of 6 residents interviewed stated that their rooms are cleaned daily, and bed sheets are changed once a week. 6 out of 6 residents interviewed stated they have seen a pest control company come to the facility and provide services. 6 out of 6 residents interviewed stated that they are overall satisfied with the facility and the services they are receiving.

During the facility inspection, the department did not observe bed bugs or any traces of them. The facility and rooms inspected were observed to be clean and sanitary.

During Record review, the department received and reviewed receipts from American City Pest & Termite dated 11/11/09/24 through 01/30/25. The department observed American City Pest & Termite has come out twice a month to provide services. S2 stated that American City Pest & Termite is scheduled to come this month to provide services as well.

Based on interviews and records reviewed, there is not sufficient evidence to support the allegation mentioned above. 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.

No deficiencies were cited during this visit.

An exit interview was conducted with, Administrator, Lida Zarafshan, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025

LIC9099 (FAS) - (06/04)

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