197608291-3-4-2025-11-AS-RORN-DEXSAH-20250320134222

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608291
Report Date: 03/04/2025
Date Signed: 03/04/2025 05:42:13 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
01/02/2025 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250102142915

FACILITY NAME:	BELMONT VILLAGE WESTWOOD		FACILITY NUMBER:	197608291
ADMINISTRATOR:	SCHROEDER, CHRIS		FACILITY TYPE:	740
ADDRESS:	10475 WILSHIRE BLVD		TELEPHONE:	(310) 475-7501
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90024
CAPACITY:	240	CENSUS: 175	DATE:	03/04/2025
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Chris Schroeder		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff did not provide medication assistance in a timely manner to resident in care.
Staff did not ensure resident's room was kept clean.
Staff did not provide good quality foods to resident in care.

INVESTIGATION FINDINGS:

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On 03/04/25, Licensing Program Analyst (LPA) Elvira Gonzalez, conducted an unannounced complaint visit to further investigate on the above listed allegations, and deliver findings. LPA Gonzalez met with Executive Director, Chris Schroeder, and the purpose of the visit was explained. LPA Gonzalez was granted access into the facility.

The investigation consisted of the following: On 01/10/25, LPA Gonzalez requested and reviewed the following documents: staff roster, resident roster, and facility menus. Conducted interviews with staff #1-#8 (S1-S8), and residents #1-#5 (R1-R5). Additionally, LPA Gonzalez conducted a tour of the entire facility with Executive Director, Chris Schroeder, inspecting a total of nine rooms, the wellness center, kitchen, bistro, and common areas. On 02/28/25, LPA Gonzalez conducted interviews with resident#6-#10 (R6-R10) via telephone. Furthermore, on 03/04/25, LPA Gonzalez requested and reviewed Medication Administration Records dated 01/01/25 - 01/31/25 for R3, and R5-R6 and conducted an inspection of three (3) public restrooms with Executive Director, Chris Schroeder.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

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 4

Control Number 11-AS-20250102142915

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: BELMONT VILLAGE WESTWOOD	FACILITY NUMBER: 197608291
	VISIT DATE: 03/04/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff did not provide medication assistance in a timely manner to resident in care. It is being alleged that there have been times where staff does not administer residents’ medication as prescribed.
On 01/10/25, between 8:55 AM – 10:30 AM, LPA Gonzalez conducted interviews with S1-S8. Based on interviews conducted, 6 out of 8 staff interviewed denied the allegation. 6 out of 8 staff interviewed communicated that resident’s medication is administered on time and as prescribed by the physician.

On 01/10/25, between 10:45 AM – 1:50 PM, LPA Gonzalez conducted interviews with R1-R5. On 02/28/25, between 2:00 PM – 3:445 PM, LPA Gonzalez conducted interviews with R6-R10. Based on interviews conducted, 6 out of 10 residents communicated that staff administers their medications on time and as prescribed by their physician. While 4 out of 10 residents communicated that they don’t know if staff administers other residents’ medication as prescribed, because they administer their own medication. 10 out of 10 residents interviewed stated they are satisfied with the services that are being provided to them.

LPA Gonzalez conducted a record review of the MARs dated: 01/01/25 – 01/31/25 and did not observe any discrepancies or mismanaging of residents’ medication.

Based on observation, interviews conducted, and a review of records, the department did not find sufficient evidence to support the allegation. 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.

Allegation: Staff did not ensure resident's room was kept clean. It is being alleged that a resident’s room, kitchen, and bathroom, was not clean.

On 01/10/25, between 8:55 AM – 10:30 AM, LPA Gonzalez conducted interviews with S1-S8. Based on interviews conducted, 8 out of 8 staff interviewed denied the allegation. 6 out of 8 staff communicated that the residents’ rooms are cleaned once a week and as needed. S1 stated that housekeeping staff deep cleans the residents’ rooms once a week, and when needed.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250102142915

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: BELMONT VILLAGE WESTWOOD	FACILITY NUMBER: 197608291
	VISIT DATE: 03/04/2025

NARRATIVE

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On 01/10/25, between 10:45 AM – 1:50 PM, LPA Gonzalez conducted interviews with R1-R5. On 02/28/25, between 2:00 PM – 3:445 PM, LPA Gonzalez conducted interviews with R6-R10. Based on interviews conducted, 10 out of 10 residents interviewed communicated that their rooms are cleaned once a week, and as needed. 10 out of 10 residents communicated that staff always maintain their room and the facility clean and sanitary.

LPA Gonzalez inspected rooms #103, #107, # 306, #307, #401, ##404, #502, #604, and #607, along with the facility Bistro, Josephine's Kitchen (facility diner), public restrooms and common areas. During the tours LPA observed the rooms, and facility to be clean and sanitary. LPA observed the public restrooms were clean and fully stocked with soap, toilet paper, and paper towels.

Based on observation, and interviews conducted, the department did not find sufficient evidence to support the allegation. 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.

Allegation: Staff did not provide good quality foods to resident in care. It is being alleged that the food provided to the residents in care was observed to be of poor or low quality and the portions were small.

On 01/10/25, between 8:55 AM – 10:30 AM, LPA Gonzalez conducted interviews with S1-S8. Based on interviews conducted, 8 out of 8 staff interviewed communicated that the facility serves good quality food, and the servings are ample. An interview with S1 communicated that the residents are served high quality, nutritious meals with a variety of options. S1 also stated that the residents are offered a second serving if they are not full. Some of the staff interviewed stated they have eaten at the facility, and that the food is good, and they feel the servings are ample.

On 01/10/25, between 10:45 AM – 1:50 PM, LPA Gonzalez conducted interviews with R1-R5. On 02/28/25, between 2:00 PM – 3:445 PM, LPA Gonzalez conducted interviews with R6-R10. Based on interviews conducted, 10 out of 10 residents interviewed communicated that the food is good, and the servings are ample. Residents also stated that they can get a second serving if they’re still hungry. 10 out of 10 residents interviewed stated that they receive three meals a day and can get snacks whenever they’d like at the Bistro.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250102142915

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: BELMONT VILLAGE WESTWOOD	FACILITY NUMBER: 197608291
	VISIT DATE: 03/04/2025

NARRATIVE

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LPA Gonzalez toured the Bistro, and the kitchen, and observed lunch being served. LPA observed that the food was visually appealing, and the portions served were ample.

LPA reviewed the facility’s menus and observed that the menus had a variety of food options, serving nutritional, well-balanced meals, including protein, whole grains, vegetables, and fresh fruits.

Based on observation, interviews conducted, and records reviewed, the department did not find sufficient evidence to support the allegation. 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 Executive Director, Chris Schroeder, and a copy of this report and appeal rights was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC9099 (FAS) - (06/04)

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