197609050-8-31-2022-11-AS-MVAO-CK4TS2-20221011145824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609050
Report Date: 08/31/2022
Date Signed: 08/31/2022 03:46:56 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 DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2022 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20220825080506

FACILITY NAME:	TERRAZA OF CHEVIOT HILLS		FACILITY NUMBER:	197609050
ADMINISTRATOR:	DOINA STEPHANIE RADU		FACILITY TYPE:	740
ADDRESS:	3340 SHELBY DR		TELEPHONE:	(310) 837-9181
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	100	CENSUS: 40	DATE:	08/31/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	ROBIN CULVER		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility illegally evicted resident

INVESTIGATION FINDINGS:

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On 8/31/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced 10-day complaint visit at this facility. LPA called the facility to conduct a risk assessment. LPA spoke with Administrator Robin Culver who confirmed the facility has one positive Covid-19 case. LPA met with Administrator Robin Culver and explained the purpose of today's visit.

The investigation consisted of the following: LPA Montoya toured the facility with Administrator Culver. LPA interviewed the alleged victim/resident (R1). LPA interviewed six other (6) residents (R2-R7) and six (6) staff (S1-S6). LPA obtained and reviewed R1’s admission agreement and other service records. LPA also requested and obtained staff roster and resident roster.

Investigation report continued in LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

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 11-AS-20220825080506

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA OF CHEVIOT HILLS	FACILITY NUMBER: 197609050
	VISIT DATE: 08/31/2022

NARRATIVE

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INVESTIGATIONS REVEALED:

Allegation: Facility illegally evicted resident

It is alleged that facility illegally evicted resident. Based on interview with the administrator (S1) and the Business Director (2), the facility has not served Resident #1 an eviction notice. S1 and S2 stated R1 was given a notice to pay only. S1 admitted because the notice given to R1 dated 8/5/22 is not an eviction letter, the facility has not notified the department about the notice. Based on LPA's review of the notice dated 8/5/2022, R1 was notified to pay $1216.83 in full by 9/5/2022. The notice states "If you fail to make payment in full of the amounts stated below within thirty (30) days after service of this Notice to you, your residency at the Community is hereby terminated thirty (30) days after service of this Notice on 8/5/2022 (the "Date of Service"). Thus, You are hereby required to move from and surrender possession of the Premises to the Community on or before 9/5/2022 (the "Date of Termination")." Interview with R1, the alleged victim, revealed the facility served him with a thick packet of letters regarding past due notices, and a notice to pay which also serves as an eviction notice. Based on LPA's review, the notice dated 8/5/2022 served to R1 is in fact an eviction letter. The facility did not provide a copy of this notice to the department to comply to Title 22. Based on interviews and record reviews, these is sufficient evidence to corroborate the allegation above.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met: "Facility illegally evicted resident" therefore the above allegation "is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D.

An exit interview was conducted, and a copy of the Complaint Report and Appeal Rights were given to Administrator Robin Culver.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220825080506

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA OF CHEVIOT HILLS	FACILITY NUMBER: 197609050
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/31/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/01/2022 Section Cited CCR 87244(f)	1 2 3 4 5 6 7	87224 Eviction Procedures (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement was not met as evidenced by.	1 2 3 4 5 6 7	The administrator shall review Section 87244 and will comply. POC shall be submitted to CCLD via email to lourdes.montoya@dss.ca.gov
	8 9 10 11 12 13 14	Based on LPA's interviews and record reviews, the facility has issued an eviction notice to resident (R1) that is not in compliance with Title 22. This poses an immediate risk to health, safety and/or personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC9099 (FAS) - (06/04)

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