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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608291
Report Date: 01/11/2022
Date Signed: 01/11/2022 03:50:30 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/05/2022 and conducted by Evaluator Troy Agard
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220105120439
FACILITY NAME:BELMONT VILLAGE WESTWOODFACILITY NUMBER:
197608291
ADMINISTRATOR:ARP, JAMESFACILITY TYPE:
740
ADDRESS:10475 WILSHIRE BLVDTELEPHONE:
(310) 475-7501
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:240CENSUS: 176DATE:
01/11/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:James Arp TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility is not following quarantine/isolation guidelines.
Staff are not trained to care for residents with COVID-19.
Administrator is not demonstrating good character.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Troy Agard initiated a 10-day complaint investigation for the allegations listed above. LPA met with Executive Director / Administrator, James Arp and explained the purpose of this visit is to gather information regarding the complaint allegation.

On 01/11/2022 LPA Agard toured the facility grounds for the main building of the Residential Care Facility for the Elderly (RCFE) and requested copies of the following: 1) a copy of the resident roster, 2) copy of staff roster, 3) any in-service training on how to use PPE. Requested documents were received at the time of visit.

On 01/11/2022, LPA Agard delivered findings.

Regarding the allegation: Facility is not following quarantine/isolation guidelines. It’s being alleged, that

Cont. 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022
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-20220105120439
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BELMONT VILLAGE WESTWOOD
FACILITY NUMBER: 197608291
VISIT DATE: 01/11/2022
NARRATIVE
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“employees and residents are in danger of serious illness and death every day. People who have covid are being allowed outside of their apartments and into the Los Angeles area.” The investigation revealed the following: 7 out of the 7 denied the allegation to be true. S1 states, “we are still allowed to do activities. We do not allow residents to leave their apartments that are positive, but if they insist, which it hasn’t happened, we cannot hold them. It’s not something we advertise.” S4 and S5 both states not everyone is allowed to work with Covid positive residents. “Not everybody can go to that room. It has to be one person assisting that person. They already have the PPE station setup.” “If a resident has Covid they are isolated. We have a cart outside the door with PPE. We talk daily to make sure we are good on supplies. We have a biohazard bin inside the room where we discard the used PPE before exiting the room. As far as I know, we do well.” During interviews with the resident the following was determined. 5 of the 5 denied the allegation to be true. R1 states, “no I don’t feel like that’s true. They have been taking very good care of us and to the best of their ability. They don’t tell us specific on who is positive due to HIPAA.

Regarding the allegation: Staff are not trained to care for residents with COVID-19. It’s being alleged, employees aren't shown or told what to do with someone who has Covid and how to be safe. The investigation revealed the following: 7 out of the 7 denied the allegation to be true. S3 states, “the facility has provided us with training. It’s not much different from what we already do. It’s just more enhanced on the hygiene. S5 states, “personally, no one is trained to deal with Covid-19. Let’s start there! Taking care of a Covid patient is the same care we already provide; the only difference is that we wear protective gear. There is no difference.” S6 states, “all staff are trained to take care of anybody that has a blood borne pathogen such as, HIV, Flu, Norovirus, which Covid 19 falls in line with those. They also have computer-based training. During interviews with the residents the following was determined: 4 of the 5 interviewed could not confirm the allegation to be true. R1-4 all state not being sure if the allegation is true or not. R3 states, I don’t know for sure, but I had someone that lived across from me that was positive, and I would see the nurses go in and they are very careful about who goes in. Everyone was always dressed in gear. R5 states the allegation is false. “I’ve been here for over 4 years. I had people come twice a day to take my temperature, we are tested weekly.”

Regarding the allegation: Administrator is not demonstrating good character. It’s being alleged, the Administrator needs to be investigated for things including inappropriate workplace comments and behavior.
Cont 9099C
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20220105120439
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: BELMONT VILLAGE WESTWOOD
FACILITY NUMBER: 197608291
VISIT DATE: 01/11/2022
NARRATIVE
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The investigation revealed the following: 7 out of the 7 denied the allegation to be true. S1 states, “we try to please everyone, but we have to make safety a priority first. To create an enriched environment during an outbreak can be challenging. S3 states, “I think my boss is a very well-spoken person. I think he is very assertive in what needs to get done and I don’t have any complaints about him. He’s very easy to speak to actually.” S5 states, “I don’t see him doing anything out of context. He speaks to everyone. He is polite. He is doing the best he can, given the situation and in general. S6 states, I like working with S1. S7 states “S1 is very direct. Sometimes people don’t like what is being said to them, but I feel like he tries his best and has gotten us through a lot.” During interviews with the residents the following was determined: 5 out of 5 denied the allegation to be true. R1 states, “he is excellent, I have been here 11 years. He has always been nice to me. Empathetic, kind and professional. This actually came in as a complaint? R3 states, “Oh that is 100% false. I’ve been here 12 years and he’s doing a superior job. R5 states, “That’s absolutely false. He’s doing a great job. He is very supportive and responsive with any issues brought to him.

LPA Agard was able to review the following records: LPA reviewed a donning and doffing in-service training, FIT testing results, a report from the department of public health with no recommendations of concern. During tour, LPA observed several stations with personal protective equipment (PPE). In a review of the facility’s mitigation plan, the facility plans to control infection by providing staff with training, physical distancing, routine cleaning of common areas, isolation rooms with dedicated staff that will work solely with infected residents. The staff will be provided with PPE.

Based on LPA’s observation, interviews conducted, record review, the preponderance of evidence standard has not been met. 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 allegations is unsubstantiated.

An exit interview was conducted, and a copy of the report was given.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3