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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608840
Report Date: 09/19/2023
Date Signed: 09/19/2023 03:50:55 PM

Unsubstantiated


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
11/17/2021 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211117083211
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:
09/19/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Dana OrdonezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility furniture is in disrepair
Resident's toilet seat is in disrepair
Resident's bathroom is dirty
Resident fell while in care
Staff are not providing adequate food service to resident's
Resident has access to hazardous items
Staff administered resident medication without physicians order
Staff did not safeguard resident's medical chart
Facility has roaches
Facility elevator is in disrepair
Unqualified staff providing care
Staff are not meeting resident hygiene needs
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 11/22/21, LPA Gonzalez conducted an interview with Administrator Patria Dufrenne and House Manager Jennifer Rivas. LPA collected copies of Staff and Resident Rosters and copies of pertinent documents related to complaint allegations. LPA also conducted a tour of the facility inside and out including facility medication room, dining rooms located on

(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: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
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 7
Control Number 28-AS-20211117083211
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: 09/19/2023
NARRATIVE
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the 1st and 2nd floors, observation/ inspection of facility elevator and inspection of the following resident rooms/ bathrooms: 101, 102, 201, 202, and 203. On 03/15/23, LPA served Investigative Subpoena Duces Tecum to CT Corporation System requesting copies of hospital records for R1. On 04/21/23, LPA received Cedar Sinai Medical Center copies of hospital records. On 09/19/23, LPA collected copies of Staff and Resident rosters. LPA interviewed Administrator Dana Ordonez, Staff 1-3 (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. LPA reviewed S1-3 files and R1-5 medications and Medication Administration Records (MARs), and also collected copies of Pest Control Invoices for October - December 2021.

Investigation revealed the following: Regarding allegation, Facility furniture is in disrepair, it is alleged that the facility patio furniture is broken was not removed. Interview with Administrator Patria Dufrenne, Administrator Dana Ordonez and S1-3 revealed that there is no facility furniture that is in disrepair. Staff stated that if any furniture is in a state of disrepair it is immediately removed. 5 out of 5 residents stated they have not seen any broken patio furniture or any other furniture in the facility or their rooms in disrepair. They stated that if something breaks or does not work they let staff know and they immediately remove any broken furniture. R1 is no longer a resident of the facility. LPA did not observe any furniture in disrepair during the tours conducted on 11/22/23 and 09/19/23. LPA observed patio furniture to be in good repair. 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 allegations, Resident's toilet seat is in disrepair and Resident's bathroom is dirty, it is alleged that resident’s toilet seat was broken, there was stool on the toilet seat and the sink was dirty. Interview with Administrator Patria Dufrenne, Administrator Dana Ordonez and S1-3 revealed that there are no broken toilet seats anywhere in the facility. Staff deny that there was stool left on a toilet seat or that any resident bathroom sink was dirty. Staff stated that if a resident accidentally soils their toilet seat, staff will immediately clean it. Staff stated that resident rooms including restrooms are cleaned on a daily basis. 5 out of 5 residents stated they have not seen any broken toilet seats. They stated that their rooms and bathrooms are cleaned every day and they do not have any concerns regarding staff not properly cleaning their toilets or bathroom sinks. They stated that if something breaks or does not work they let staff know and they
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 28-AS-20211117083211
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: 09/19/2023
NARRATIVE
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immediately remove any broken item and replace it. R1 is no longer a resident of the facility. LPA did not observe any broken toilet seats, any stool in toilet seats and observed bathroom sinks to be clean during the tours conducted on 11/22/23 and 09/19/23. LPA observed bathrooms to be clean and in good repair. 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 allegation, Resident fell while in care, it is alleged that a facility resident fell due to broken patio furniture not being removed and facility staff allegedly said that this resident falls a lot and to just leave the resident on the floor. Interview with Administrator Patria Dufrenne, Administrator Dana Ordonez and S1-3 revealed that there has no incident in which a resident has fallen due to facility furniture that is in disrepair. Staff deny that any resident fell and was just left there by facility staff. Staff stated that if any resident falls for any reason they are immediately assisted and proper assessment is conducted of the resident as well as any appropriate follow up medical attention if it is needed. Staff stated that if any furniture is in a state of disrepair it is immediately removed so that there is no danger of any resident tripping or falling. 5 out of 5 residents stated they have not fallen due to broken patio furniture being a hazard. They stated that furniture throughout the facility is not in disrepair. They stated that if something breaks or does not work they let staff know and they immediately remove any broken furniture. R1 is no longer a resident of the facility. LPA did not observe any furniture in disrepair during the tours conducted on 11/22/23 and 09/19/23. LPA observed patio furniture to be in good repair. 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 allegation, Staff are not providing adequate food service to resident's, it is alleged that facility residents are not being feed enough food because resident is always complaining about being hungry. It is also alleged that resident was being served cold food and non-nutritional food like the drink Hi-C which was served warm. 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. They stated that they are not served or given non-nutritional drinks like Hi-C and stated that if they are still hungry after eating any meal they can request additional servings. They stated that food is not served cold if it supposed to be warm and stated that the drinks are not served warm. R1 is no longer a resident of the facility. Administrator and facility staff stated that food is ordered weekly to ensure that there is
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 28-AS-20211117083211
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: 09/19/2023
NARRATIVE
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enough food in stock for resident's daily dietary consumption. Staff stated that the food served to residents is healthy, they receive three full meals and 2 snacks per day. They stated that they do not serve or give residents non-nutritional drinks like Hi-C and stated residents can request additional servings of any meals. Staff stated that food is not served cold if it supposed to be warm and stated that the drinks are not served warm. 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 did not observe the drink Hi-C. 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 allegation, Resident has access to hazardous items, it is alleged that cleaning products and a mop were in residents shower. Interview with Administrator Patria Dufrenne, Administrator Dana Ordonez and S1-3 revealed that cleaning products or cleaning items such as a mop are never left in any residents showers. Staff stated that all cleaning products are kept locked and inaccessible to residents in care and stated that staff immediately store the cleaning products and cleaning items once they are done using them. 5 out of 5 residents stated they have not seen any cleaning products or cleaning items such as a mop left in their bathrooms/ showers. They stated that their rooms and bathrooms are cleaned every day and staff do not leave anything behind. R1 is no longer a resident of the facility. LPA did not observe any cleaning products or cleaning items such as mops in any residents showers that were inspected during the tours conducted on 11/22/23 and 09/19/23. LPA observed bathrooms to be clean and in good repair. 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 allegation, Staff administered resident medication without physicians order, it is alleged that a facility staff stated that R1 was being given medications that are not prescribed to them. Interviews conducted with Administrator Dufrenne, and facility staff revealed that facility residents receive their medications at the proper dosage times on a daily basis as prescribed. Facility staff stated that when medication is given to residents staff will initial appropriate resident MAR each time medication is given. Staff stated that only prescribed medication is given to residents. Interviews conducted 5 out of 5 facility residents revealed that they do not have any concerns regarding medication management and indicated that they receive their medications at the appropriate times that they have to take them. 5 out of 5 residents stated that they are only given medications that are prescribed to them by their doctors. LPA reviewed R1-5 MARs records and
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 28-AS-20211117083211
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: 09/19/2023
NARRATIVE
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observed that medication is given to residents at correct times and then properly initialed by staff. On 09/19/23, LPA observed as staff was administering medications to facility residents and did not observe anything of concern. LPA observed some residents request their medications and also observed staff call residents to come to medication room to get their medications. Based on interviews conducted with facility staff, facility residents, LPA observations and LPA review of records, there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff did not safeguard resident's medical chart, it is alleged that a resident's chart went missing and was found on top of their microwave. Interviews conducted with Administrator Dufrenne, and facility staff revealed that facility residents charts are only kept in the medication room and are not taken out to any other section of the facility. Facility staff stated that when medication is given to residents staff will initial appropriate resident MAR each time medication is given and filed back. They stated that for residents that the staff dispense the medications in their rooms, staff will update resident files in the medication room after they return from giving the resident their medications. Interviews conducted 5 out of 5 facility residents revealed that they do not have any concerns regarding medication management and indicated that they receive their medications at the appropriate times that they have to take them. 5 out of 5 residents stated that they have not seen staff take files out of the medication room and that staff update their files once they are given their medications. On 09/19/23, LPA observed as staff was administering medications to facility residents and did not observe anything of concern. LPA observed files in the medication room and observed that the room is locked and only staff are allowed in the medication room. Based on interviews conducted with facility staff, facility residents, LPA observations and LPA review of records, there was not enough supportive evidence to concur with the reported allegation.

For allegation, Facility has roaches, it is alleged that the facility has roaches. Interviews with Administrator Dufrene and staff revealed that the facility does not have roaches. They stated that they have not been notified by any facility resident or facility staff that there are roaches in the facility. Staff stated that the facility gets treated by pest control monthly. 5 out of 5 residents interviewed stated that there are no roaches at the facility. They stated that the facility staff clean their rooms on a daily basis and stated that they have also seen that pest control treats the facility regularly. LPA Gonzalez conducted a tour of the facility inside and out including facility medication room, dining rooms located on the 1st and 2nd floors, and inspection of the following resident rooms/ bathrooms: 101, 102, 201, 202, and 203 and did not see any evidence of roaches in the areas inspected. LPA also reviewed Pest Control invoices which indicate that the facility is treated monthly for insects, rodents and other types of vermin. Based on interviews conducted with facility staff, facility residents, and LPA observations and record review, there was not enough supportive evidence to concur with the reported allegation.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 28-AS-20211117083211
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: 09/19/2023
NARRATIVE
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For allegation, Facility elevator is in disrepair, it is alleged that the facility elevator is broken. Interviews conducted with staff revealed that the facility has 1 elevator and it is not in disrepair. 5 out of 5 residents interviewed confirmed that the elevator is working and is not in disrepair. LPA observed that the elevator was operating properly during the visits that were conducted on both 11/22/21 and 09/19/23. LPA tested the elevator twice on 09/19/23 at different times and verified that the elevator is not in disrepair and was operating properly at the time of the visit. Residents and staff were also observed using the elevator. 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 allegation, Unqualified staff providing care, it is alleged that there is no security, and no one is checking to see who is entering the facility, the facility is short staffed, and the staff are not certified in California but are allowed to work while they get their certification. It is also alleged that it is hard to get a hold of the facility manager. Interviews conducted with facility staff revealed that they are properly trained. LPA reviewed 3 staff files and observed in-service training on topics such as CPR/ First Aid, Medication Administration, Activities of Daily Living, Licensing requirements, and mandated reporter to list a few. Interview with Administrator Dufrenne and facility staff revealed that Administrator is present at the facility 5-6 days a week. Administrator Dufrenne and staff stated that the facility has adequate staffing at all times and she is present at the facility almost every day. Administrator stated that she always ensures that the facility is fully staffed to provide proper care and supervision to facility residents which includes proper supervision and observations of who is coming in and out of the facility. Administrator stated that the facility does not have security but there is always staff in the front desk as that is where residents go when they need something. She also stated that her office has a view of the front door. Interviews conducted with 5 out of 5 residents revealed that the administrator is at the facility everyday and that she is available to them if they have any concerns. They stated that they are overall satisfied with their stay at the facility and believe that the staff are properly trained. LPA reviewed facility schedule and observed that administrator is present on facility premises the number of hours necessary to manage facility. Administrator stated that when she is not present she ensures that there is coverage by a designated substitute, Facility Manager Jennifer Rivas, who meets qualifications for proper administration of the facility. Based on statements gathered from interviews conducted with facility staff, facility residents, as well as LPA review of staff files and LIC500 there was not enough supportive evidence to concur with the reported allegation.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 28-AS-20211117083211
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: 09/19/2023
NARRATIVE
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For allegation, Staff are not meeting resident hygiene needs, it is alleged that a facility resident was not being cleaned, resident’s toenails were long and had not been cut and their hair had not been combed. It is also alleged that when resident was hospitalized their sodium levels were high which means that the resident was dehydrated. 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. Staff stated that they ensure that residents nails are not long as well as ensure that their hair is combed. Staff stated that a podiatrist visits the facility on a monthly basis and provides services such as cutting toenails for residents that need that service. Administrator stated that R1 was hospitalized due to other medical conditions and not due to being dehydrated. 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. 1 resident stated that they get monthly podiatrist visits and the podiatrist assists with cutting their toenails. 4 residents stated that they do not need assistance with cutting their toenails, showers or with combing their hair. R1 is no longer a resident of the facility. LPA also observed the residents to be dressed appropriate with clean clothes, hair appeared brushed, no bad odor and observed resident nails to be trimmed. Residents were observed to have good hygiene. LPA reviewed R1's medical records which revealed that R1 was seen at Cedars Sinai Medical Center on 11/13/21 for other medical reasons and did not observe on the medical records that R1 was seen due to being dehydrated. 5 out of 5 residents state that they not have any concerns regarding their hygiene needs. Based on interviews conducted with facility staff, and facility residents, LPA review of medical records and observations, 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: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7