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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608840
Report Date: 09/18/2023
Date Signed: 09/18/2023 04:32:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2021 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211013152647
FACILITY NAME:BEVERLY HILLS SENIOR CAREFACILITY NUMBER:
197608840
ADMINISTRATOR:ANNIE JIANGFACILITY TYPE:
740
ADDRESS:1015 S. ORANGE GROVE AVENUETELEPHONE:
(323) 933-8271
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:0CENSUS: 0DATE:
09/18/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Dana OrdonezTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Resident in care has scabies at the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Dana Ordonez and explained the reason for the visit.

The facility is under a new change of ownership, effective 12/08/22; therefore, LPA Gonzalez will mail findings to (former) Licensee.

The investigation consisted of: During the initial visit conducted on 10/21/21, LPA Gonzalez conducted an interview with Administrator Patria Dufrenne and LPA collected copies of Staff and Resident Rosters. On 02/14/23, LPA emailed/ faxed Investigative Subpoena Duces Tecum to UCLA Health Release of Information


(See LIC9099C for continuation)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
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 8
Control Number 28-AS-20211013152647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 197608840
VISIT DATE: 09/18/2023
NARRATIVE
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requesting copies of hospital records for R1. On 03/03/23, LPA received UCLA Medical Center copies of hospital records. On 09/18/23, LPA collected copies of Staff and Resident rosters. LPA interviewed Administrator Dana Ordonez, Staff 1-4 (S1-3), Residents 1-5 (R1-5), reviewed R1's facility file and collected copies of documents pertinent to investigation. LPA additionally conducted a tour of the facility which consisted of inspection of facility lobby, kitchen, dining room, a random selection of resident rooms which included resident private bathrooms.

Investigation revealed the following: Regarding allegation, Resident in care has scabies at the facility, it is alleged that on 10/12/21, R1 was seen at a UCLA medical clinic with evidence of a scabies infection. Interview with Administrator Patria Dufrenne revealed that R1 did not report to staff that they had a scabies infection and that there are no residents at the facility with scabies infection. She stated that R1 is a very private person and does not keep staff informed of doctor appointments or outcomes of their doctor appointments. Administrator stated that R1 never informed staff that they were diagnosed with scabies and did not inform staff that they were prescribed medication to treat scabies. Administrator stated that R1 was able to take care of themselves, was independent and did not require any assistance with Activities of Daily Living (ADLs). LPA reviewed R1's records which indicated that R1 did not need assistance with bathing and can care for all personal needs. LPA review of R1's UCLA Medical Center hospital records revealed that R1 was seen at a UCLA medical clinic on 10/12/21 and was diagnosed with scabies. R1 was prescribed medication to treat the scabies rash. R1 was not interviewed as they are no longer a resident of the facility.

Based on LPA review of medical records, the preponderance of evidence standard has been met; therefore, the above mentioned allegation is found to be SUBSTANTIATED. Deficiencies are being cited according to Title 22.

Facility has been closed as of 12/07/22. Reason for closure was change of ownership.

Exit interview was not conducted, a hard copy of the Complaint Report, and Appeal Rights will be mailed to Licensee New Home for Me, Inc.'s (#197608840) last known mailing address.

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 28-AS-20211013152647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 197608840
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2023
Section Cited
CCR
87466
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87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs.
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Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Administrator to submit a faxed or mailed copy of POC by due date.
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The requirement was not met as evidenced by: LPA reviewed medical reoords that confirmed that R1 had a scabies infection when seen at a UCLA clinic on 10/12/21 and was prescribed medication to treat the scabies rash, which poses a potenial 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.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2021 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211013152647

FACILITY NAME:BEVERLY HILLS SENIOR CAREFACILITY NUMBER:
197608840
ADMINISTRATOR:ANNIE JIANGFACILITY TYPE:
740
ADDRESS:1015 S. ORANGE GROVE AVENUETELEPHONE:
(323) 933-8271
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:0CENSUS: 0DATE:
09/18/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Dana OrdonezTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility does not meet resident's personal care and hygiene needs.
Facility did not return resident's personal belongings after hospitalization.
Resident is not being adequately fed at the facility.
Resident does not have access to a phone while in care.
Facility staff did not ensure that resident attended medical appointments.
Facility did not provide transportation for resident to attend a medical appointment.
Facility does not provide a safe environment for resident.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Dana Ordonez and explained the reason for the visit.

The facility is under a new change of ownership, effective 12/08/22; therefore, LPA Gonzalez will mail findings to (former) Licensee.

The investigation consisted of: During the initial visit conducted on 10/21/21, LPA Gonzalez conducted an interview with Administrator Patria Dufrenne and LPA collected copies of Staff and Resident Rosters. On 02/14/23, LPA emailed/ faxed Investigative Subpoena Duces Tecum to UCLA Health Release of Information


(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 28-AS-20211013152647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 197608840
VISIT DATE: 09/18/2023
NARRATIVE
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requesting copies of hospital records for R1. On 03/03/23, LPA received UCLA Medical Center copies of hospital records. On 09/18/23, LPA collected copies of Staff and Resident rosters. LPA interviewed Administrator Dana Ordonez, Staff 1-4 (S1-3), Residents 1-5 (R1-5), reviewed R1's facility file and collected copies of documents pertinent to investigation. LPA additionally conducted a tour of the facility which consisted of inspection of facility lobby, kitchen, dining room, a random selection of resident rooms which included resident private bathrooms.

Investigation revealed the following: Regarding allegation, Facility does not meet resident's personal care and hygiene needs, it is alleged that on 10/12/21, R1 was seen at a UCLA medical clinic and they arrived to the clinic wearing dirty clothing, smelling of urine, and it appeared that the resident tried to do their own laundry. Interview with Administrator Patria Dufrenne, Administrator Dana Ordonez and S1-3 revealed that facility staff do meet all resident's personal care and hygiene needs. They stated that residents that are able to take care of their own Activities of Daily Living (ADLs) are encouraged to take a shower everyday and are provided the proper hygiene products. Staff stated that they always shower residents that require assistance per their schedule and/ or if they had an accident, they will give residents an extra shower to make sure they are clean. They stated that if a resident refuses or asks staff to come back at a later time, staff will ensure to go back and assist the resident(s) with their shower and if a resident refuses to shower it is properly documented. Staff stated that all facility residents are provided with the proper hygiene supplies at all times and their laundry is done twice a week and as needed. Administrator stated that R1 was able to take care of themselves, was independent and did not require any assistance with Activities of Daily Living (ADLs). LPA reviewed R1's records which indicated that R1 did not need assistance with bathing and can care for all personal needs. 1 out of 5 residents stated they get showered twice a week and staff always give them a shower on their shower day. 4 residents stated that they are independent and do not require shower assistance and stated that the facility provides them with hygiene products/ needs. 5 out of 5 residents state that they not have any concerns regarding their laundry and stated that their laundry is done timely twice a week. R1 is no longer a resident of the facility. Based on interviews conducted with facility staff, and facility residents, there was not enough supportive evidence to concur with the reported allegation.

For the allegation, Facility did not return resident's personal belongings after hospitalization, it is it is alleged that on 10/12/21, R1 was seen at a UCLA medical clinic and reported to medical staff that when they were hospitalized in early 2021, the facility took some of their belongings and did not give them back and due
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 28-AS-20211013152647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 197608840
VISIT DATE: 09/18/2023
NARRATIVE
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to that they only has a few items of clothing. Interview with Administrator Dufrenne and facility staff revealed that facility staff do not take any resident belongings. She stated that staff do not go in to resident rooms and take their belongings even when they are hospitalized. Administrator stated that R1 did not report to staff that they were missing any personal belongings when they returned back from the hospital. Staff stated that R1 seemed to always be mad and repeatedly made false allegations about staff. S1-3 deny ever taking any items from resident rooms. Interviews conducted with 5 out of 5 residents revealed that facility staff respect their belongings and have never taken any of their belongings. 5 out of 5 residents stated that staff always knock before coming into their rooms. 5 out of 5 residents stated that they are satisfied with all the services they get at the facility and stated that they do not have any concerns, and staff are very helpful and always assist them when they need assistance. R1 is no longer a resident of the facility. LPA observed staff knocking and announcing themselves before going into resident rooms. Based on LPAs observations, and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

For the allegation, Resident is not being adequately fed at the facility, it is alleged that on 10/12/21, R1 was seen at a UCLA medical clinic and reported to medical staff that they are not given enough food to eat on the weekends and sometimes is only given a hot dog and french fries. Interviews conducted with 5 out of 5 residents revealed that they are satisfied with the food service provided at the facility. They stated that the food is healthy, they receive three full meals and 2 snacks per day. R1 is no longer a resident of the facility. Administrator and facility staff stated that food is ordered weekly to ensure that there is enough food in stock for resident's daily dietary consumption. LPA toured the facility kitchen and observed facility menu posted and observed an ample amount of food. There was enough food for 7 days non perishables and 2 day perishables. LPA observed the facility serves meals that are well balanced with a selection of fruits and vegetables. Based on LPA observations, and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

For the allegation, Resident does not have access to a phone while in care, it is alleged that UCLA Medical staff had to call repeatedly to get in contact with R1 as they do not have a phone and is not provided with a phone in their room. Interviews conducted with 5 out of 5 staff revealed that the facility does provide a phone for resident use. They stated that many residents have their own personal cell phones but the resident's that do not have a cell phone use the facility when they need to make calls or receive a call. They stated that if a resident is not in the facility when a phone call comes in for them, staff will take a message
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 28-AS-20211013152647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 197608840
VISIT DATE: 09/18/2023
NARRATIVE
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and give it to the resident. Interviews conducted with 3 out of 5 residents revealed that they have a personal phone and do not use the facility phone but stated that if they ever need to use the facility phone it is available for resident use. 2 out of 5 residents stated that they do have access to a phone at the facility and stated that the staff also provide them with a message if they were not at the facility when they got a call. R1 is no longer a resident of the facility. Interviewed residents did not have any concerns. LPA observed two facility residents using the facility phone during the visit. Based on interviews conducted with facility staff, facility residents, and LPA observations, there was not enough supportive evidence to concur with the reported allegation.

For the allegation, Facility staff did not ensure that resident attended medical appointments, it is alleged that R1 had not been seen at a UCLA medical clinic for the past year. R1 also did not show up to multiple follow-up appointments. Interviews conducted with Administrator Dufrenne and Ordonez revealed that facility staff ensure that residents keep their medical appointments at all times. They stated that the facility doctor comes in once a month but if a patient has a personal doctor they ensure that those residents are keeping their appointments. Administrator Dufrenne stated that R1 was a very private person and did not keep staff informed of doctor appointments or outcomes of their doctor appointments. Administrator stated that R1 never informed staff when they had appointments. Administrator stated that R1 was able to take care of themselves, was independent and did not require any assistance with Activities of Daily Living (ADLs). LPA reviewed R1's records which indicated that R1 did not need assistance with bathing and can care for all personal needs. Interviews conducted with 4 out of 5 residents revealed that the facility ensures that they are seen by a doctor once a month and as needed. 1 out of 5 residents stated that they have their own private doctor and they make their own appointments but that staff ensure that they attend their medical appointments. R1 is no longer a resident of the facility. Interviewed residents did not have any concerns. Based on interviews conducted with facility staff, and facility residents, there was not enough supportive evidence to concur with the reported allegation.

For the allegation, Facility did not provide transportation for resident to attend a medical appointment, it is alleged that on 10/12/21, R1 only attended their clinic visit after clinic staff arranged transportation for R1 to go to clinic. Interviews conducted with Administrator Dufrenne and Ordonez revealed that facility staff ensure that residents keep their medical appointments at all times and that they have transportation set up. They stated that most residents use Access and public transportation and the facility will also set up Uber/ Lyft transportation services. Administrator stated that R1 never informed staff when they had appointments. Administrator stated that R1 was able to take care of themselves, was independent and did not require any
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 28-AS-20211013152647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 197608840
VISIT DATE: 09/18/2023
NARRATIVE
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assistance with Activities of Daily Living (ADLs). LPA reviewed R1's records which indicated that R1 did not need assistance with bathing and can care for all personal needs. Interviews conducted with 4 out of 5 residents revealed that they do not have any concerns with staff not meeting their medical needs and that they see the facility doctor once a month. 1 out of 5 residents stated that they have a personal doctor and either get to their medical appointments by Access or if they are not able to set up an Access transportation appointment the facility staff provide transportation to their appointments. R1 is no longer a resident of the facility. Based on statements gathered from interviews conducted with staff, residents and LPA review of documents, there was not enough supportive evidence to concur with the reported allegation.

For the allegation, Facility does not provide a safe environment for resident, it is alleged that the facility is neglecting a facility resident and it also appears that the resident's personal care and housing conditions are unsafe. Interviews conducted with 5 out of 5 staff revealed that the facility has enough staff on schedule to meet the needs of the facility residents and provide a safe environment at all times. Staff stated that there are no residents that are being neglected and all resident's personal care and housing conditions are a top priority. Staff indicated they have not received any concerns from any resident pertaining to not feeling safe at the facility. Interviews conducted with 5 out of 5 residents revealed that they feel safe at the facility. They denied that they are being neglected by facility staff and stated that they are satisfied with the services that they receive at the facility. They also stated that the facility has enough staff on schedule and that facility staff meet their daily needs. 5 out 5 residents stated that staff respond quickly if they need assistance and stated that staff conduct rounds and check in on residents every 2 hours. R1 is no longer a resident of the facility. LPA reviewed facility schedule and observed that there is enough staff on schedule to properly provide a safe environment for facility residents, facility operation and tend to residents daily needs. Based on interviews conducted with facility staff, facility residents, and LPA record review, there was not enough supportive evidence to concur with the reported allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Facility has been closed as of 12/07/22. Reason for closure was change of ownership.

Exit interview was not conducted, a hard copy of the Complaint Report, and Appeal Rights will be mailed to Licensee New Home for Me, Inc.'s (#197608840) last known mailing address.

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 8 of 8