197603601-10-27-2022-11-AS-JHAD-CKXNNY-20221107093727

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603601
Report Date: 10/27/2022
Date Signed: 10/27/2022 03:12:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
10/20/2022 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221020171622

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:	10/27/2022
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Ilana Yazdi & Lida Zarafshan		TIME COMPLETED:	03:11 PM

ALLEGATION(S):

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Staff did not address a resident's change in medical condition.

INVESTIGATION FINDINGS:

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On 10/27/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced visit at this facility and was greeted by Administrator Lida Zarafsahan and Controller Ilana Yazdi. LPA spoke to Yazdi prior to entering the facility to conduct a risk assessment. Yazdi informed LPA that the facility has no COVID cases nor do any of the residents or staff have symptoms. LPA explained the purpose of this visit is to investigate the allegation mentioned above.

The investigation consisted of the following: Interview with facility administrator Zarasfsha (S1) and staff #2-#3 (S2-S3), witnesses #1 (W1), and resident #1-#8 (R1-R8) A reveiw of (R1's) service records and other pertinent documents associated with this complaint. An entire tour of the facility was conducted with Yazdi.

Evaluation Report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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-20221020171622

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS LOVING CARE	FACILITY NUMBER: 197603601
	VISIT DATE: 10/27/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff did not address a resident's change in medical condition.
The details of the complaint alleges the staff did not address resident #1 (R1's) change in medical condition. The complainant states the (R1) has ongoing issues in which mental, financial and medical self neglect are ongoing concerns. According to the complainant, the facility staff and management are compliant. There is no "neglect or lack of care" for (R1) at this facility. (R1) is being provided shelter, food and assisted daily living activities (ADLs) as well as in-house medical physician for (R1's) health services. The complainant reported it is (R1) who is not in compliant with the rules and regulations and there are concerns for (R1's) mental and physical health condition who refuses to receive medical care. (R1) self-admitted at this facility on 8/29/22. Since (R1's) admittance, (R1) has an obligation to pay rent which he has not comply since his move-in. The complainant states (R1) was served with an 30-Day Notice to Vacate on 10/12/22.

The Department interviewed resident #1 (R1) who was unwilling to release any information. (R1) admitted refusal to medical services provided by facility. (R1) gave inconsistent information in regard to his eviction. The Department observed the facility continues to provide shelter, meals, medications and care services to (R1). These services have not been interrupted in lieu of the resident's eviction. Interviews conducted with residents #2-#8 (R2-R8) were complimentary of overall operation of staff and management. (R2-R8) claimed the staff are responsive to changes in their medical condition and did not have issues on this matter. Interviews with (S1-S3) verified the facility continues to provided shelter and services to (R1) and there has been no neglect or lack of care in association to (R1's) well-being. (S1-S3) verified (R1) has been served with a 30-Day Notice to Vacate for failure to comply with the Admissions Agreement despite multiple warnings and counseling.

Based on the information gathered, an inspection of the facility, observation, analysis of (R1’s) service records, and interviews conducted, the Department found no evidence to support the allegation mentioned in this complaint.

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.

An exit interview was conducted with Yazdi, and a copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC9099 (FAS) - (06/04)

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