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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603601
Report Date: 04/17/2024
Date Signed: 04/17/2024 03:46:39 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
04/12/2024 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240412095519
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: 80DATE:
04/17/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Lida Zarafshan/AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not adequately assist resident with mobility needs.
Staff accepted money outside of monthly rent fees from resident.
INVESTIGATION FINDINGS:
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On 4/17/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Lida Zarafshan /Administrator and explained the purpose of this visit.

Investigation Consisted of: Interview with Administrator(A#1), Facility Staff (S#1-S#5), Residents (R#1-R#8), Witnesses (W#1 and W#2) and Reporting Party (RP). LPA Iniguez reviewed the following records: Staff Roster, Residents Roster, (R#1-R#5) Physicians Report for Residential Care Facilities for the Elderly or LIC 602, (R#1-R#5) Admissions Agreement, (R#1-R#5) Identification and Emergency Information LIC 625, (R#1-R#5) Appraisal/Needs Service Plan LIC 625, (R#1-R#5) Medication Administration Record (MARS) for the month of March 2024, copies of staff training regarding residents falls.

Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
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 5
Control Number 11-AS-20240412095519
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: 04/17/2024
NARRATIVE
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Investigation Revealed the Following:

Allegation: Staff did not adequately assist resident with mobility needs.

The details of the complaint alleged that facility staff are did not adequately assist resident with mobility needs while in care.



As part of the records review, LPA carefully examined (R#1)'s Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A. According to the report, (R#1)'s mental condition does not hinder their ability to make decisions, follow instructions, or communicate their needs. Moreover, (R#1) can transfer to and from the bed independently and uses a walker as an assistive device.

During interview with the Administrator (A#1), she mentioned that the facility takes several measures to prevent residents from falling. These measures include in-services for all employees, regular checks on residents' medications to determine if there are any changes that might increase the risk of falling and advising residents to pull the call cord to receive assistance in getting up and prevent falling. (A#1) also stated that (R#1) has fallen no more than four times recently, and only twice recently. However, if a resident falls consecutively, the facility will immediately inform their physician and family. The facility also provides fall prevention services for all staff every three months, and all staff members are available to assist residents whenever they ask for help.

During an interview with witnesses (W#1 and W#2), they both confirmed that they perceive (R#1) as safe and well taken care of at the facility. They also agreed that whenever (R#1) requests assistance from the staff, they are prompt to come and help, although it may take around 20 minutes. Furthermore, (W#1) and (W#2) clarified that (R#1) has only fallen twice recently, and not more than that. They also stated that the staff is not responsible for (R#1)'s falls.



Evaluation Report continues LIC 9099-C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20240412095519
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: 04/17/2024
NARRATIVE
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During interviews with residents (R#2-R#8), (7) out of (7) residents stated that they feel safe living here and that they get assistance from staff when they request it. In addition, (7) out of (7) state that they have not fallen due to lack of help from staff.

During interviews with staff (S#1-S#5), (5) out of (5) staff members stated that the facility has a process in place that allows them to identify fall-risk residents; also, they said that when a resident needs assistance, they always use the "call light" and we go and check on them. In addition, (5) out of (5) staff members stated that they do not know (R#1) falling more than four times recently or another resident in care; also, they stated that they received training every three months regarding Fall Prevention and they all state that when (R#1) or another resident in care needed assistance, they always providing it.


Allegation: Staff accepted money outside of monthly rent fees from resident.

The details of the complaint alleged that facility accepted money outside monthly rent fees from resident.



During the records review, LPA Iniguez examined (R#1)'s admission agreement. The agreement stated that the facility is not responsible for managing (R#1)'s finances and that the family is responsible for it.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20240412095519
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: 04/17/2024
NARRATIVE
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During an interview with the administrator (A#1), it was mentioned that (R#1)'s family, (W#1) and (W#2), manage their finances, and that (R#1) does not have any money with them at the facility. Additionally, (A#1) stated that the facility staff, including herself, do not accept gifts or tips from residents. If a resident wishes to give the staff a gift or a tip, they must inform the administrator beforehand. This is because some residents in care have a medical condition that would make them forget about it, and they will not remember giving the gift the next day. However, it is okay for families to provide gifts. Furthermore, (A#1) denies any financial abuse towards (R#1) or any other resident in her care.

During an interview with witnesses (W#1 and W#2), both stated that (R#1) does not give monetary tips to facility staff since (W#1) manages (R#1) financial affairs. Also, they both state that facility staff has yet to ask (R#1) for extra money. In addition, both (W#1) and (W#2) state that they feel they can trust the facility staff to take care of (R#1).

During interviews with residents (R#2-R#8), (7) out of (7) residents stated that they do not give monetary tips to facility staff, and facility staff has yet to ask them for additional money. In addition, (7) out of (7) state that they feel they can trust the facility staff to take care of them.

During interviews with staff (S#1-S#5), all (5) staff members categorically denied receiving monetary tips from (R#1) or any other resident in care. They also vehemently denied any instances of financial abuse towards (R#1) or any other resident in care, thereby affirming their integrity.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20240412095519
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: 04/17/2024
NARRATIVE
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During this investigation, LPA found did not find sufficient evidence to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.


According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.



An exit interview was conducted, and a copy of the Complaint Report was given to Lida Zarafshan /Administrator.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5