197608840-12-5-2022-28-AS-RORN-CM42SU-20221213163942

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608840
Report Date: 12/04/2022
Date Signed: 12/05/2022 12:17:52 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
02/08/2022 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220208124749

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: 37	DATE:	12/04/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Patria Dufrenne		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not respect resident's privacy
Staff took an item from resident's room without permission
Staff made inappropriate comments towards resident
Staff are not providing discharge planning services 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 Patria Dufrenne and explained the reason for the visit.

The investigation consisted of: During the initial visit conducted on 2/14/22, LPA Gonzalez conducted an interview with Administrator Patria Dufrenne and Resident 1 (R1). LPA collected copies of Staff and Resident Rosters. LPA reviewed R1's facility file and collected copies of pertinent documents related to complaint allegations. LPA also collected contact information for R1's Exodus Case worker. 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. LPA attempted to reach Exodus Case Worker but was unsuccessful.

(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: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

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-20220208124749

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: 12/04/2022

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff did not respect resident's privacy, it is alleged that on 2/5/22 a facility staff entered a resident's room without permission. Interview with Administrator Dufrenne revealed that facility staff never enter a resident's room without permission. She stated that staff always knock and ask for permission to come in before entering any resident room and stated that staff respect resident's privacy at all times. Interview conducted with House Manager Jennifer Rivas revealed that she always asks for permission before going into any resident room. She stated that all facility residents are treated with dignity and respect at all times. She stated that facility rooms are shared and if staff need to talk to just one resident they will ask the other resident for a moment so that they can talk to the intended resident. She stated that if for any reason a resident cannot leave their room, staff will talk to the resident privately in the office. S1-2 stated that staff always respect all resident's privacy and they announce themselves before going into a room to assist a resident, and/ or clean their room. House Manager and S1-2 denied ever going into a resident's room without first announcing themselves and stated that all resident's privacy is respected at all times. Interviews conducted with 4 out of 5 residents revealed that facility staff respect their privacy. 4 out of 5 residents stated that staff always knock before coming into their rooms. 4 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 help. 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.

Regarding allegation, Staff took an item from resident's room without permission, it is alleged that on 2/5/22 a facility staff took a resident's oxygen concentrator that had just been delivered. Staff told resident that the item belonged to someone else with the same name. When resident asked staff to see paperwork that stated who the item belonged to, the staff refused to show the resident. Interview with Administrator Dufrenne revealed that facility staff do not take any resident belongings. She stated that staff do not go in to resident rooms and just take things. She stated that there are not two residents with the same name at the facility. She stated that R1 does not use an oxygen concentrator and stated that she has not received an order from R1's doctor informing her that R1 needs an oxygen concentrator. She stated that there are no residents at the facility who currently use an oxygen concentrator. Interview conducted with House Manager Jennifer Rivas revealed that she did not go into R1's room and take anything from belongs to the resident. Ms. Rivas denies taking an oxygen concentrator and stated that R1 just accused her out of nowhere.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)981-3982
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220208124749

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: 12/04/2022

NARRATIVE

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She stated that there have not been any deliveries of oxygen concentrators, stated that there are no residents that use an oxygen concentrator and stated that there are not two resident's with the same name at the facility. She stated that R1 seems to always be mad and repeatedly makes false allegations about staff. S1-2 deny ever taking any items from resident rooms. S1-2 stated that when resident's have deliveries they are immediately notified and if they are not in the facility then the item is held in the office so that the resident can pick up from the office. S1-2 stated that there are not any residents at the facility who are using oxygen concentrators. Interviews conducted with 4 out of 5 residents revealed that facility staff respect their belongings and have never taken any of their belongings. 4 out of 5 residents stated that staff always knock before coming into their rooms. 4 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. 1 out of 5 residents stated that they do not have an order from a doctor stating that they need an oxygen concentrator and stated that due to a decline in their health which their doctor is aware of, they need an oxygen concentrator. LPA reviewed R1's file and did not see a doctor order for an oxygen concentrator. LPA also reviewed resident roster and did not observe that there are any residents listed with the same name. LPA observed staff knocking and announcing themselves before going into resident rooms. Based on LPAs observations, review of records and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff made inappropriate comments towards resident, it is alleged that a facility staff told a facility resident that staff do not need permission to go into a resident's room and staff do not need to ask for permission to go into resident rooms and take items. Interview conducted with Administrator Dufrenne revealed that staff treat residents with respect at all times and do not make inappropriate comments to residents. Administrator stated that she has not ever seen any staff treat any resident inappropriately or make inappropriate comments to residents. Administrator stated that she has not gotten any concerns from facility residents about staff making inappropriate comments to them regarding going into their rooms as they please or anything else. Interviews conducted with House Manager Rivas and S1-2 revealed that they do not make inappropriate comments to residents and have never told residents that they can go into their rooms whenever they want and take their belongings. 4 out of 5 residents stated that staff always knock if they want to come into their rooms and stated that staff have never made any inappropriate comments to them. 4 out of 5 residents stated that they are happy with the treatment of staff as well as all other services that they receive

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)981-3982
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 28-AS-20220208124749

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: 12/04/2022

NARRATIVE

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at the facility. LPA observed staff knocking and announcing themselves before going into resident rooms. LPA also observed staff notify residents of deliveries that they have waiting at the office. 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 allegation, Staff are not providing discharge planning services for resident, it is alleged that facility staff have not began a resident's discharge plan after a change in the resident's condition for which the resident now needs a higher level of care. It is also alleged that facility administrator did not inform resident's family of a meeting even after resident requested for their family to be present. Interview conducted with Administrator Patria Dufrenne revealed that she works closely with R1's Case Manager/ Social Worker and they are working on finding R1 another placement. R1 has expressed that they want to live in a smaller facility and eventually independently. Administrator stated that R1 is independent and was placed at the facility by Department of Health Services. She stated that R1 had not had a change in condition since moving into the facility. Interviews conducted with House Manager Rivas revealed that resident's are provided with assistance and finding placement if a resident has a change in condition that requires a higher level of care. She stated that if staff observe that any resident is experiencing a change in their condition they will notify the administrator so that the resident can be reassessed as well as taken to their doctor. LPA reviewed R1's file and did not see doctor paperwork or any documents indicating a change in condition or anything stating that R1 needs a higher level of care. LPA did not observe any documents or notes stating that the resident had been observed to have a change in condition or had been reassessed due to a change in condition. Interviews conducted with 4 out of 5 residents stated that they are happy living at the facility and with all of the services that they receive at the facility. Based on 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 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: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC9099 (FAS) - (06/04)

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