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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608467
Report Date: 02/10/2026
Date Signed: 02/10/2026 01:59:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/02/2025 and conducted by Evaluator Raymond Comer
COMPLAINT CONTROL NUMBER: 31-AS-20250502154634
FACILITY NAME:BELMONT VILLAGE HOLLYWOODFACILITY NUMBER:
197608467
ADMINISTRATOR:JANELLE TOPETEFACILITY TYPE:
740
ADDRESS:2051 N HIGHLAND AVETELEPHONE:
(323) 874-7711
CITY:LOS ANGELESSTATE: CAZIP CODE:
90068
CAPACITY:150CENSUS: 126DATE:
02/10/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Janelle TopeteTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Due to lack of supervison, resident eloped from the faciltiy.
INVESTIGATION FINDINGS:
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At 10:00 am, Tuesday, 2/10/25, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct a subsequent visit regarding the allegation listed above. LPA conducted an initial complaint visit on Monday, 05/12/25, at which time LPA received Facility resident and staff roster. From 10:30 am to 11:15 am, LPA conducted interviews with the Reporting Party, (RP) and the Administrator. From 11:30 pm to 12:00 pm, LPA conducted an interview with Resident#1's responsible familiy member (F1).

On today's visit, LPA met with facility Administrator, presented official CDSS badge identification, and reason for the visit was disclosed.

At 10:15 am, LPA conducted a physical plant tour; no health and safety issues were observed.

[LIC 9099C] Continued-
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026
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 31-AS-20250502154634
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BELMONT VILLAGE HOLLYWOOD
FACILITY NUMBER: 197608467
VISIT DATE: 02/10/2026
NARRATIVE
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Allegation: Due to lack of supervision, resident eloped from the facility. It was alleged that resident #1 (R1) was found on the street sitting down on the sidewalk. R1 was found by a couple walking on the street. Suspecting that R1 was a resident of the facility, staff were contacted. R1 was identified and returned back to the facility.

LPA interviews with the Administrator and Staff verified the following: On the evening of 4/8/25, R1 eloped from the facility via a courtyard door located in the enclosed patio. An audio alarm alerted staff that the door had been opened. However, staff could not identify which patio door was open. At around 10:00 pm, staff was alerted by an unknown individual that R1 was sitting on the sidewalk, near to the facility. R1 was returned to the facility with staff assistance.

A review of records verified that R1 cannot leave facility unassisted. Incident report previously submitted to the licensing office also supported the information revealed by interviews.
Based on interviews and records review, there is sufficient information and evidence to support the allegation.
Therefore, the allegation is substantiated at this time.

The citation was issued and recorded on LIC9099D.
An immediate civil penalty of $500.00 also was issued to the facility at the time of this visit.
Exit interview was conducted and a copy of report was issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250502154634
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BELMONT VILLAGE HOLLYWOOD
FACILITY NUMBER: 197608467
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/10/2026
Section Cited
HSC
1569.312(e)
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Every facility required to be licensed ...shall provide at least the following basic services: (e) Monitoring the activities of the residents while...under the supervision of the facility to ensure their general health, safety, and well being. This requirement is not met as evidenced by:
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Administrator will conduct an in-service training to staff regarding how to prevent resident elopiements from the facility. POC will be submitted by 2/20/26. Within 24 hours, Admin will provide plan of action regarding steps to prevent further elopments.
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Based on LPA interviews and records review, (R1) walked out the courtyard patio door of the facility on the evening 4/8/25 without staff's awareness. This is an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026
LIC9099 (FAS) - (06/04)
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