197608467-2-1-2022-31-AS-NMAN-CDXS8L-20220429133915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608467
Report Date: 02/01/2022
Date Signed: 02/01/2022 02:39:39 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, 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
01/27/2022 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20220127100401

FACILITY NAME:	BELMONT VILLAGE HOLLYWOOD		FACILITY NUMBER:	197608467
ADMINISTRATOR:	YOUNG, ALLYSON L		FACILITY TYPE:	740
ADDRESS:	2051 N HIGHLAND AVE		TELEPHONE:	(323) 874-7711
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90068
CAPACITY:	150	CENSUS: 83	DATE:	02/01/2022
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Allyson Young - Executive		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility does not have hot water for the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegation. LPA met with Executive Director Allyson Young and explained the reason for the visit.

LPA conducted physical plant tour at around 9:45 AM, requested facility documents relevant to the investigation at 10:30 AM and interviewed staff and residents between 11:00 AM to 12:45 PM. It was alleged that there was no hot water in some residents' room. LPA interview with the Maintenance Engineer (ME) today at around 11:00 AM revealed that a certain section of the building has fluctuating hot water for about three (3) weeks now. LPA measured the water temperature at the affected section's rooms and measured at a range of 105.0°F to 115.0°F. Non-affected rooms were also measured at a range of 116.2°F to 119.8°F. Further interview with ME and Executive Director (ED) also revealed that they have called multiple plumbing companies to fix the problem to no avail, the hot water still fluctuates and they are continuously working on it to date. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220127100401

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BELMONT VILLAGE HOLLYWOOD	FACILITY NUMBER: 197608467
	VISIT DATE: 02/01/2022

NARRATIVE

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(continued from LIC 9099)

LPA's interview with residents also revealed that they were offered to move to another room but did not want to so they were offered to use the vacant room's bathroom to shower or whatever they need it for, which some of the residents do. LPA's interview with the ED confirmed that they did offer not only to move or use vacant room's bathroom to shower but some compensation for the inconvenience.

Based on the information gathered during this visit, the facility did what they supposed to and continue to do so to resolve the issue and offered alternative solutions to the affected residents, therefore, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

LIC9099 (FAS) - (06/04)

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