197603601-5-24-2023-11-AS-MVAO-CSCTHF-20230531144442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603601
Report Date: 05/24/2023
Date Signed: 05/24/2023 04:18:09 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
01/07/2022 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220107103647

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: 85	DATE:	05/24/2023
		UNANNOUNCED	TIME BEGAN:	03:29 PM
MET WITH:	Lida Zarafshan		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility failed to safeguard residents property.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 05/24/2023, Licensing Program Analyst (LPA) Perry Scott conducted a continuation of a complaint visit that was done on 01/11/2022. LPA Scott met with Administrator, Lida Zarafshan (S1) and Administrator Controller, Ilana Yazdi (S2), and explained the purpose of this visit is to deliver findings from a previous complaint.

On 1/11/22, Licensing Program Analysts (LPAs) Martessa Brown and Gail Johnson initiated an unannounced complaint investigation regarding the above listed allegation. LPAs was met by Lida Zarafshan, the facility Administrator and Ilana Yazdi, the Director. LPA explained the purpose of today’s visit.

The investigation consisted of the following:

On 1/11/22 LPAs toured the physical plants, bedrooms, bathrooms, dining rooms, kitchen area, TV rooms and outside shaded area. LPAs conducted Health and Safety check and Residents appeared to be doing fine. LPA requested obtained Resident & Staff Roster and requested the following documents: Recent Incident Reports by 1/12/22.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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 2

Control Number 11-AS-20220107103647

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: 05/24/2023

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

The investigation revealed the following: Regarding allegation #1: Facility failed to safeguard residents’ property.

On 05/24/23, LPA interviewed S1-S6. 6 of 6 staff all denied the allegation that the Facility failed to safeguard residents’ property. All staff reported that there was never an incident where one resident stole another residents’ wheelchair. All staff states that the resident is confused and did not have a wheelchair upon admittance. LPA conducted a review of the residents’ (R1) file and on the client/resident personal property and valuables form, there is no mention of a wheelchair, only personal clothing.

Moreover, on the residents clothing and possessions form there isn’t anything that states the resident had a wheelchair upon admittance to the facility. S1 stated that there is a safe in S2s office that can be used by the residents if they have valuables to store. They would need to itemize the inventory on a document, sign, and then store it in the safe. Otherwise, they all have keys to their rooms and can lock the door once they leave.

On 05/24/23, LPA interviewed R1-R10. R2-R10 denied the allegation that the Facility failed to safeguard residents’ property. R2-R10 all state that the facility does a great job at safeguarding their valuables. R1 stated that a resident was seated in the dining-room and R1s wheelchair was lined up with other wheelchairs to the side. When R1 went to retrieve R1s wheelchair, it was missing. R1 indicates that R1 has seen another resident with R1s wheelchair (name of other resident is unknown). LPA interviewed residents and staff and could not corroborate that the incident occurred.

Based on interviews and records reviewed there is insufficient evidence to support the allegation: Facility failed to safeguard residents’ property. 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.

There were no deficiencies cited on today’s visit.

An exit interview has been conducted and a copy of the Complaint Report was provided to Administrator, Lida Zarafshan.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2