197608840-6-16-2022-28-AS-SCOL-CFSU3R-20220627151359

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608840
Report Date: 06/16/2022
Date Signed: 06/16/2022 02:47:49 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, 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
06/08/2022 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220608145624

FACILITY NAME:	BEVERLY HILLS SENIOR CARE		FACILITY NUMBER:	197608840
ADMINISTRATOR:	ANNIE JIANG		FACILITY TYPE:	740
ADDRESS:	1015 S. ORANGE GROVE AVENUE		TELEPHONE:	(323) 933-8271
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90019
CAPACITY:	45	CENSUS: 42	DATE:	06/16/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Patria Dufrenne		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are giving residents medications that are not prescribed to them

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Patria Dufrenne and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Patria Dufrenne, Staff 1-4 (S1-4) and Residents 1-4 (R1-4). LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1-4 facility files including Medication Administration Records (MARs) and collected copies of MARs for R1-4 for March 2020 - June 2020. LPA additionally conducted a tour of facility which included observations of common areas, dining room, resideent rooms and medication room.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

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 28-AS-20220608145624

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 197608840
	VISIT DATE: 06/16/2022

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff are giving residents medications that are not prescribed to them, it is alleged that facility staff have been told to give Lorazepam and Terazapam to all the facility residents located on the 1st and 2nd floor to make the residents go to sleep so that the staff do not have to deal with them. It is alleged that staff Mike and Mandy who are both male also give the residents Lorazepam and Terazapam, which are medications that are not prescribed to the residents. Interview conducted with Administrator Patria Dufrenne revealed that facility staff only give residents the medication that is prescribed to each individual resident. Interviews conducted with S1-4 revealed that only prescribed medications are given to residents. S1-4 denied that they give residents Lorazepam to sedate them. S1-4 stated that Lorazepam is only given to residents that have a prescription for the medication. S1-4 stated that once medications are given to residents they then initial each resident's MAR. LPA researched medication, Terazapam, and LPA research did not reveal a medication with that name. Interviews conducted with 4 residents revealed that they are satisfied with their medication management and do not have any concerns. R1-4 stated that they are aware of what medications they take, are given their medications on a timely manner by staff and have not been given any medications that are not prescribed to them by facility staff. LPA reviewed R1-4 MARs and did not observe anything that is of concern. LPA's observations of facility medication room did not reveal anything of concern. LPA did not observe any stand alone medications such as Lorazepam or any other sedatives in the medication room. 4 out of 4 clients stated that they are satisfied with the services that they receive at the facility and stated that facility staff treat them with respect at all times. Based on LPA observations, LPA review of documents and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

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.

Exit interview held. A copy of the report was provided to Administrator Patria Dufrenne.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC9099 (FAS) - (06/04)

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