197608840-12-7-2021-28-AS-MVAO-CATSJ2-20220119125425

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608840
Report Date: 12/07/2021
Date Signed: 12/07/2021 03:57:09 PM

Substantiated

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
12/01/2021 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211201153706

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:	12/07/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Patria Dufrenne		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Residents are not afforded privacy in their rooms
Resident's room is in disrepair

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 allegations. LPA met with Administrator Patria Dufrenne and explained the reason for the visit.

The investigation consisted of: LPA conducted an interview with Administrator Patria Dufrenne, Residents 1-5 (R1-5), House Manager Jennifer Rivas and Caregiver Brianna Eufracio. LPA obtained copies of Staff and Resident Rosters and copies of facility maintenance receipts. LPA conducted a tour of the facility inside and out including, dining rooms located on the 1st and 2nd floors, observation/ inspection of random resident rooms which also included restrooms in each room. Resident rooms/ bathrooms that were inspected were: 101, 102, 103, 104, 106, 108, 201, 202, 205, 208, and 213. On 12/6/21, LPA conducted a telephone interview with LTCO (Long Term Care Ombudsman) representative and received an email from LTCO which included photographs.

(See LIC9099C for continuation)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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 4

Control Number 28-AS-20211201153706

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: 12/07/2021

NARRATIVE

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The investigation revealed the following: Regarding allegation, Residents are not afforded privacy in their rooms, it is alleged that doors of resident rooms are being held open with items such as plastic bags or hangers (pictures provided). These items were placed on the doorknobs of the doors of the residents' room and tied to the handle of their closets. LPA conducted an interview with Administrator Dufrenne who stated that residents continue to use such mechanisms to keep the doors open and it is mainly an issue on the main floor. She stated that residents are continuously told that they cannot keep the door open in that manner due to safety reasons and nothing else but residents continue to use such items to keep their doors open. Administrator and staff interviewed stated that residents are given privacy. Staff stated that they continuously tell residents that it is not safe for them to keep their doors open with items such as hangers, plastic bags or ties as it is a fire and safety hazard. 3 out of 5 residents that were interviewed stated that they do use items such as hangers or plastic bags to keep their doors open and stated that is the only way to keep the doors propped open. 1 out of 5 residents stated that staff are the ones that place a hanger on the door knob to keep the door open. Administrator stated that she is working with Global Fire Technologies so that proper and safe mechanisms can be installed to hold the doors open if residents chose to keep them open. She stated that one hold up is that many resident rooms have a closet behind the door so it is hard to attach a magnet to be used to keep doors open if a resident chooses to do so. LPA conducted a tour and observed several doors being held open by hangers, plastic bags and shoe laces.

For allegation, Resident's room is in disrepair, it is alleged that there is a hole in the roof of a resident's room (pictures provided). LPA conducted a tour of resident rooms on the first and second floor and did not observe any holes on ceilings but did observe that the ceiling had been patched up after plumbing work had been completed in a number of resident rooms located on the main floor. Interview with Administrator revealed that there is an ongoing plumbing issue that she is currently working with a licensed plumber to fix. She stated that she had previously paid a plumber to fix leaks in some resident rooms but the issues persisted. She stated that the plumber had to make holes in certain rooms to get to where the leak was but the holes were then sealed off and patched. 1 out of 5 residents stated that they had experienced an ongoing issue with a leak in their bathroom that was taken care of but had subsequently began to leak again. Administrator stated that initial plumber seemed to have only temporarily fixed the plumbing issue which is the reason that she is working with a new plumber to get to the main issue regarding the leakage problem and to get to a more permanent solution for the leakage problem.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20211201153706

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 12/23/2021 Section Cited CCR 87468.2(a)(1)	1 2 3 4 5 6 7	Additional Personal Rights of Residents in Privately Operated Facilities To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not met as evidence by:	1 2 3 4 5 6 7	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.
	8 9 10 11 12 13 14	Based on interviews conducted with staff, residents and LPA observations which revealed that materials such as hangers, trash bags and shoe laces or cords are being used to keep room doors open, which poses a potential safety risk to residents in care.	8 9 10 11 12 13 14
Request Denied Type B 12/23/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Based on interviews conducted with staff, residents, LTCO Representative,	1 2 3 4 5 6 7	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.
	8 9 10 11 12 13 14	LPA observations and review of documents it was determined that facility has an ongoing plumbing issue that has resulted in holes and leakage on ceiling, which poses a potential safety risk to residents in care.	8 9 10 11 12 13 14

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: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 28-AS-20211201153706

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: 12/07/2021

NARRATIVE

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Based on interviews conducted with facility staff, and LPA observations, the preponderance of evidence standard has been met; therefore, the above mentioned allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, are being cited on attached LIC9099D.

Exit interview was conducted with Administrator Patria Dufrenne. LPA was only able to get page 1 of LIC9099 signed as LPA experienced computer related issues. LPA informed administrator that due to LPA having computer issues LPA was unable to assess computer to get additional signatures and to print report. A hard copy of the report was provided via email for signature. A copy of the report and appeal rights were provided to Administrator.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC9099 (FAS) - (06/04)

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