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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609050
Report Date: 05/26/2023
Date Signed: 05/26/2023 10:40:13 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
08/24/2022 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220824084810
FACILITY NAME:TERRAZA OF CHEVIOT HILLSFACILITY NUMBER:
197609050
ADMINISTRATOR:DOINA STEPHANIE RADUFACILITY TYPE:
740
ADDRESS:3340 SHELBY DRTELEPHONE:
(310) 837-9181
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:100CENSUS: 40DATE:
05/26/2023
UNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Cecilio Sapp-Business ManagerTIME COMPLETED:
10:39 AM
ALLEGATION(S):
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9
Resident's rates were raised without proper notification.
INVESTIGATION FINDINGS:
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On 5/26/23 Licensing Program Analyst (LPA) Alfonso Iniguez conducted a subsequent complaint investigation for the above listed allegations. LPA met with Cecilio Sapp-Businnes Manager and the purpose of the visit was explained to deliver findings.

On 9/1/22, Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced initial complaint investigation for the allegations listed above. LPA met with Robin Culver, Executive Director and Cecilio Sapp, Business Manager and explained the purpose of today's visit. LPA toured the entire facility and conducted interviews with the Executive Director, staff #1-2 and residents #1-4. LPA obtained staff/resident roster and requested the following documents: residents #1-4 Admission Agreements and addendums, needs and services, emergency contacts and any fee increase notices due by 9/2/22.

Investigation revealed the following.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
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 5
Control Number 11-AS-20220824084810
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: TERRAZA OF CHEVIOT HILLS
FACILITY NUMBER: 197609050
VISIT DATE: 05/26/2023
NARRATIVE
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Allegation #2: Resident's rates were raised without proper notification. It was alleged on 8/23/22 resident was told the rent was going to increase monthly and owes money. Administrator informed R1 will need to pay in full by 9/1/22. LPA conducted interview with R1 on 9/1/22, resident stated was told on the 8/23/22 the rent will increase. R1 stated was in the rears for payment and owes back. LPA interviewed R2-R4, and residents had no concerns with not being notified of improper rent increased. LPA interview Administrator and office manager stated residents are notified of the rent increase 60 days in advance. LPA interviewed staff S3-S4, and they stated had no concerns of residents receiving proper notice of rent increase. LPA reviewed R1’s notice dated 4/21/22 and notice indicated as of 1/1/22, R1’s current Social Security increased and current rent will be $1211.00. The notice also indicated R1’s rent increase will be effective 7/1/22. LPA reviewed R1’s statement for the month of May 2022-October 2022. 5/2022 Statement showed resident started being billed the pro-rated amount of rent effective (3/23/22-3/31/2022) and there rent increase charge. On 5/22/23, LPA interviewed Cecilio Sapp-Office Manager regarding R1 not receiving the increase on the effective date 1/1/22 and was informed facility did not have an office manager to bill residents. Based on investigation and Pins 21-23-CCLD and 22-10 -CCLD. R1 was not provided the proper 60-day notice rent increase. The department found sufficient information to substantiate the above allegation.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met: “Resident's rates were raised without proper notification.” 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 Cecilio Sapp.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 11-AS-20220824084810
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA OF CHEVIOT HILLS
FACILITY NUMBER: 197609050
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2023
Section Cited
CCR
1569.655(a)(d)
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1569.655 Increase in fee rates for elderly residents 60 days written notice stating amount of and reason for increase; application of section
(a)-(d) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days prior …
This requirement was not met as evidenced by:
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Administrator will come up with a plan on how they will ensure residents are given a proper 60-day notice of rate increase and comply with Title 221569.655(a)-(d). Administrator will send to LPA Alfonso Iniguez by the by POC due date.
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Based on observation and interviews conducted, Licensee did not ensure R1 was given a proper 60-day notice, and this poses a potential health and safety risk to residents in care in care.
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Type B
06/07/2023
Section Cited
CCR
87405(b)(2)
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87405 Administrator - Qualifications and Duties
(b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations.
This requirement was not met as evidenced by:
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Administrator will come up with a plan on how they will ensure they will confirm with the laws, rules and regulation and to ensure residents rights are not violated. Administrator will send to LPA Alfonso Iniguez by the by POC due date.

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Based on observation and interviews conducted, administrator did not take into the consideration the resident overall financial status which is a personal rights violation. this poses a potential health and safety risk to residents in care.
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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 AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
08/24/2022 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220824084810

FACILITY NAME:TERRAZA OF CHEVIOT HILLSFACILITY NUMBER:
197609050
ADMINISTRATOR:DOINA STEPHANIE RADUFACILITY TYPE:
740
ADDRESS:3340 SHELBY DRTELEPHONE:
(310) 837-9181
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:100CENSUS: 40DATE:
05/26/2023
UNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Cecilio Sapp-Business ManagerTIME COMPLETED:
10:39 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to treat resident with dignity and respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On Licensing Program Analyst (LPA) Alfonso Iniguez conducted a subsequent complaint investigation for the above listed allegations. LPA met with, the facility and the purpose of the visit was explained to deliver findings.

On 9/1/22, Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced initial complaint investigation for the allegations listed above. LPA met with Robin Culver, Executive Director and Cecilio Sapp, Business Manager and explained the purpose of today's visit. PA toured the entire facility and conducted interviews with the Executive Director, staff #1-2 and residents #1-4. LPA obtained staff/resident roster and requested the following documents: residents #1-4 Admission Agreements and addendums, needs and services, emergency contacts and any fee increase notices due by 9/2/22.

Investigation revealed the following.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20220824084810
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: TERRAZA OF CHEVIOT HILLS
FACILITY NUMBER: 197609050
VISIT DATE: 05/26/2023
NARRATIVE
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Allegation #1: Staff failed to treat resident with dignity and respect. It was alleged that administrator threw residents’ food supplies on the floor. On 9/1/22 LPA conducted interviews with Resident regarding above allegation R1 stated food supplies had been on the counter for 4 days. R1 stated Administrator came in the room and threw food supplies down. LPA conducted interviews with (R2-R4), residents stated they are treated fine by the staff and do not have any concerns with being treated with respect. On 9/1/22 and 5/19/23, LPA conducted interviews with Robin Culver-Executive Director, regarding the above allegation, she stated R1 has been storing old food and supplies in the room and doesn’t want items remove. She stated due to food items being old, requested to have them remove along with storage containers. She stated R1 also orders a lot of food and likes to hort food. Interviews conducted interview with staff S1-S3, stated resident are treated with respect and had no concerns. Based interviews conducted and observations, the department did not find sufficient evidence to support allegation the above allegation.

Unsubstantiated: “Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. California Code of Regulations.



Exit interview was conducted with Cecilio Sapp and a copy of the report was given.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5