197608840-11-10-2022-28-AS-MVAO-CL7TFF-20221115134127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608840
Report Date: 11/10/2022
Date Signed: 11/10/2022 02:41:56 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
12/28/2020 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201228094709

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: 43	DATE:	11/10/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Patria Dufrenne		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident was left on soiled linens for an extended period of time.
Resident's linens are not adequately laundered.

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 Patria Dufrenne and explained the reason for the visit.

The investigation consisted of: During the initial visit conducted on 1/6/21, LPA Gonzalez conducted a telephone interview with Administrator Dufrenne. LPA requested copies of Staff and Resident Rosters. On 11/10/22, LPA interviewed Administrator Patria Dufrenne, House Manager Jennifer Rivas, Staff 1-2 (S1-2) and Residents 1-4 (R1-4). LPA reviewed R1-4's facility files and collected copies of various documents pertinent to the investigation. LPA also conducted a tour of facility including lobby, dining room, common areas on both 1st and 2nd floor, laundry room and a random selection of resident rooms. LPA collected copies of Staff and Resident Rosters.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)981-3982
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

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-20201228094709

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: 11/10/2022

NARRATIVE

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Investigation revealed the following: Regarding allegation, Resident was left on soiled linens for an extended period of time, it is alleged that a facility resident was found in bed lying in urine soaked and stained sheets. Interview with Administrator Dufrenne revealed that at no time has a resident been left in soiled linens for a long period of time. She stated that there are some residents that require assistance with Activities of Daily Living (ADLs) and that staff tend to them immediately when there has been an accident. She stated that every resident has a call button and staff respond to an alert immediately to check on residents and tend to their needs. S1-2 stated that that staff immediately respond when a resident pushes their call button and stated that residents are not made to wait for long periods of time. S1-2 denied that any resident has ever been left on soiled linens for an extended period of time. They stated that if a resident has had an accident the longest a resident will wait is from the time a resident pushes the call button to when the staff reaches the resident in their room. They stated that it will only be of 2-5 minutes and not longer than that. Staff stated that if a resident happens to not use a call button they are constantly conducting rounds and checking in on residents to see if they need any assistance or help with anything. Interviews conducted with 4 out of 4 residents revealed 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. 3 residents stated that they have never had to wait for long periods of time before a staff comes to assist them. 2 residents that require assistance with ADLs stated that they are happy with the care that they receive on a daily basis and stated that they have never been left in soiled linens for an extended period of time. LPA observed staff assisting residents and did not observe anything of concern. Based on LPAs observations, 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.

For allegation, Resident's linens are not adequately laundered, it is alleged that facility staff did not know when a resident's linens were last changed and also did not know when a resident was last dialyzed. Interview conducted with Administrator Patria Dufrenne revealed that residen'ts linens are cleaned on a daily basis and as needed depending if a resident has had an accident. Administrator stated that R1 attended dialysis 3 times per week and does not know which staff might have made a statement stating that they did not know when R1 last attended dialysis treatment. She stated that R1 would refuse treatment at times and staff had to work closely with the resident. R1 was not interviewed as they are no longer a resident of the facility. R1 was hospitalized December 2020 due to complications with COVID19 and did not return to the

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)981-3982
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20201228094709

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: 11/10/2022

NARRATIVE

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facility. Interviews conducted with House Manager Rivas and S1-2 revealed that resident's linens are laundered every day. Staff stated that linens are also immediately washed if a resident has an accident. LPA toured the facility laundry room and observed that the facility has a washer and dryer as well as products needed to wash resident's clothes and linens. Staff stated that resident's laundry is done twice a week and as needed. 4 out of 4 residents stated that their linens are cleaned daily and their laundry is done twice a week. 4 out of 4 residents stated that if they need any clothing to be washed for them outside of the scheduled laundry days staff will do it for them. 4 out of 4 residents stated that they are happy with the laundry services as well as all other services that they receive at the facility. 4 out of 4 residents stated that staff respond to a call button signal in an appropriate amount of time, they are never made to wait for long periods of time and stated that staff are very helpful at all times. 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.

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.

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

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)981-3982
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

LIC9099 (FAS) - (06/04)

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