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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603601
Report Date: 05/24/2023
Date Signed: 05/24/2023 04:21:03 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
06/18/2021 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210618160313
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: 85DATE:
05/24/2023
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Lida ZarafshanTIME COMPLETED:
03:26 PM
ALLEGATION(S):
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Facility has cockroaches
Residents have scabbies
Bathrooms are moldy
Carpets are dirty
Furniture is falling apart
INVESTIGATION FINDINGS:
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On 05/24/2023, Licensing Program Analyst (LPA) Perry Scott conducted a continuation of a complaint visit that was done on 06/21/2021. 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 06/21/2021, Licensing Program Analyst (LPA) Martessa Brown initiated a complaint investigation for the allegations listed above. LPA met with Ilana and Lida, the facility's Administrators.

Investigation consisted of the following:

LPA Brown interviewed the Administrators. LPA conducted a Health and Safety Check. LPA toured the facility’s physical plants: Tv rooms, kitchens/dining areas, bathrooms, and bedrooms. LPA observed carpet on the 2nd floors stairs and residents R1 bedroom that needed to be clean. LPA did not observe any broken furniture during visit. Residents in the facility appeared to be fine. LPA obtained residents roster and requested the following documents to be sent by 6/25/21: Staff Roster & Pest Control Invoices. It has been determined that further documentation is needed.

On 05/24/2023, the investigation consisted of the following:

During today’s visit LPA toured the entire facility. LPA interviewed staff S1-S6, residents R1-R10. LPA reviewed files, obtained copies of staff and resident rosters; ID emergency information, physicians report, appraisals/needs and service plan for residents R1-R10 and pest control invoices.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (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 3
Control Number 11-AS-20210618160313
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
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The investigation revealed the following: Regarding allegation #1: Facility has cockroaches.

On 05/24/23, LPA interviewed S1-S6. 6 of 6 all denied the allegation that the Facility has cockroaches. All staff stated that the facility has a contract with a pest control company that comes bi-weekly to treat for pests. LPA verified this account by gathering invoices from the pest control company. LPA conducted a tour of the facility, including bedrooms, bathrooms, kitchen, and other parts of the facility where the residents congregate; and LPA did not notice any cockroaches in the facility.

On 05/24/23, LPA interviewed R1-R10. 9 of 10 residents all denied the allegation that the Facility has cockroaches. Most of the residents stated that the facility does not have cockroaches. While one resident stated that they have seen one or two, but nothing that would cause concern.

Based on interviews, observations, and records reviewed there is insufficient evidence to support the allegation: Facility has cockroaches. 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.

Regarding allegation #2: Residents have scabies

On 05/24/23, LPA interviewed S1-S6. 6 of 6 staff all denied the allegation that the Residents have scabies. All staff stated that whenever there is a confirmed case of an infectious disease, they would notify the Department of Health and Community Care Licensing once the doctor has confirmed the diagnosis. LPA reviewed 10 focused and random resident files, which contained physicians’ reports, appraisal/needs and service plans; there were no reports in the file that confirms the residents ever had scabies. One staff stated that there are a lot of trees around the facility which brings mosquitos in contact with the residents, and they are bitten. S1 went on to say that there has not been a confirmed case of scabies by a doctor.

On 05/24/23, LPA interviewed R1-R10. 10 of 10 residents denied the allegation that Residents have scabies. All residents interviewed denied that they personally had the disease or new of anyone else in the facility that had it.

Based on interviews, observations, and records reviewed there is insufficient evidence to support the allegation: Residents have scabies. 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.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (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 3
Control Number 11-AS-20210618160313
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
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Regarding allegation #3: Bathrooms are moldy.

On 05/24/23, LPA interviewed S1-S6. 6 of 6 staff all denied the allegation that the Bathrooms are moldy. All staff corroborated that the bathrooms and rooms are cleaned daily and that there is no mold in the bathrooms. Some staff went on to say that depending on the resident and their situation, the bathrooms are cleaned multiple times during the day. LPA conducted a tour of the facility which included the bathrooms and did not observe any signs of mold.

On 05/24/23, LPA interviewed R1-R10. 10 of 10 residents denied the allegation that the Bathrooms are moldy. All residents stated that there was no issue with mold in their bathrooms.

Based on interviews and observations there is insufficient evidence to support the allegation: Bathrooms are moldy. 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.

Regarding allegation #4: Carpets are dirty.

On 05/24/23, LPA interviewed S1-S6. 6 of 6 staff all denied the allegation that the Carpets are dirty. All staff commented that they haven’t had carpeting in years. And that all carpeting has been removed and replaced with hardwood flooring. LPA conducted a tour of the facility and observed that the flooring has been replaced with hardwood floors and there was not any sign of dirty carpets or a dirty facility.

On 05/24/23, LPA interviewed R1-R10. 10 of 10 residents denied the allegation that the Carpets are dirty. All residents maintain that the facility is doing a good job cleaning the facility daily.

Based on interviews and observations there is insufficient evidence to support the allegation: Carpets are dirty. 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.

Regarding allegation #5: Furniture is falling apart.

On 05/24/23, LPA interviewed S1-S6. 6 of 6 staff all denied the allegation that the Furniture is falling apart. All staff maintained that the furniture in the facility is in good repair. LPA conducted a tour of the facility and did not find any furniture that was in disrepair or falling apart.

On 05/24/23, LPA interviewed R1-R10. 10 of 10 residents denied the allegation that the Furniture is falling apart. All residents maintain that the furniture is in good repair and that they have not noticed any of the furniture to be falling apart.

Based on interviews and observations there is insufficient evidence to support the allegation: Furniture is falling apart. 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 HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (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: 3 of 3