<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608291
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:24:06 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
02/28/2023 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230228153629
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: 171DATE:
03/09/2023
UNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Chris Schoreder TIME COMPLETED:
01:57 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility physical plant is unsafe.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/09/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint visit. Upon arrival at the facility, LPA verified if any individuals with COVID-19 activity. Based on the assessment, the facility is cleared of COVID-19 infection. LPA met with Executive Director Chris Schhroeder. LPA explained the purpose of today's visit.

The investigation consisted of the following: LPA interviewed staff #1 (S1) Executive Director, witness #1--#2 (W1-W2) asked questions relevant to the nature of the complaint. A toured the facility inside to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. An inspection of room #227 and all the common areas.

Evaluation Report continues LIC 9099,
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
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-20230228153629
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: BELMONT VILLAGE WESTWOOD
FACILITY NUMBER: 197608291
VISIT DATE: 03/09/2023
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
INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility physical plant is unsafe.

The details of the complaint alleged the facility's physical plant is unsafe. The complainant reported life-threatening heavy or sharp objects on revised surfaces without anchoring them. The complainant requested for Community Care Licensing (CCLD) to inspect the bookcases and accent table with ceramic pots and sharp-edge decorative materials are not fastened in place.

The inspector of the Bureau of Fire Prevention inspected 03/09/23 at this facility and did not find any bookshelves positioned near any exit passageways. Since the existing bookshelves were positioned near furniture on which guests and occupants may sit, it was recommended that the facility anchor the bookshelves to the wall to prevent any items on the shelves or the bookshelves themselves from falling on nearby individuals. The Executive Director staff # (S1) informed the inspector and (CCLD) that management will have all bookshelves anchored to the wall. According to (S1), a request through the corporate office was made on 03/09/23. The item the complainant referred to was not sharp and is found on the bookshelves or end tables throughout the common areas and was not a health or safety issue or violated fire and safety codes.

(CCLD) inspected all the communal areas, including the library, kitchen, bistro, dining, activity room, and resident apartment #227. The Department did not observe the facility in an unsafe condition to residents in care, and it is in incompliance with Title 22 Regulations.

Based on the information gathered, (CCLD) did not find sufficient evidence to support the allegation "Facility physical plant is unsafe."



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 Chris Schroeder, and a copy of the report provide.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2