197609311-10-20-2021-11-AS-AJKK-C8DKPF-20211102080439

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609311
Report Date: 10/20/2021
Date Signed: 10/20/2021 01:32:33 PM

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
09/22/2021 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210922142330

FACILITY NAME:	WATERMARK AT BEVERLY HILLS, THE		FACILITY NUMBER:	197609311
ADMINISTRATOR:	STEPHANIE WALTERS		FACILITY TYPE:	740
ADDRESS:	220 N CLARK DRIVE		TELEPHONE:	(310) 860-9234
CITY:	BEVERLY HILLS	STATE: CA	ZIP CODE:	90211
CAPACITY:	75	CENSUS: 40	DATE:	10/20/2021
		UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Stephanie Walters		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident(s) are not being provided adequate services.
Staff don’t answer the phone.
Facility is in disrepair.
Staff spoke inappropriate about resident.
Facility not following COVID protocols.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Troy Agard initiated a subsequent complaint investigation for the allegations listed above. LPA met with Executive Director / Administrator, Stephanie Walters and explained the purpose of this visit is to gather information regarding the complaint allegation.

On 10/01/2021 LPA Agard toured the facility grounds for the main building of the Residential Care Facility for the Elderly (RCFE) and requested copies of the following: 1) a copy of the resident roster, 2) copy of staff roster 3) Physician Report 4) Email correspondents regarding facility disrepairs. Requested documents were received at the time of visit.

On 10/20/2021, LPA Agard delivered findings.

Regarding the allegation: resident(s) are not being provided adequate services. It’s being alleged that the facility is not providing a resident with medication administration and vitals due to staff shortage. The
Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

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 3

Control Number 11-AS-20210922142330

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: WATERMARK AT BEVERLY HILLS, THE	FACILITY NUMBER: 197609311
	VISIT DATE: 10/20/2021

NARRATIVE

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investigation revealed the following. R2-6 either did not report having issues with medication administration or did not need that level of support. R1 expressed not wanting support with medication due to their fear of the covid-19 outbreak. R1 states that they do not wish to pay the additional cost associated with the support of medication administration. S1 states the facility has medication technicians onsite and R1 refused support for medication administration due to not wanting to pay the additional cost. S2,3,5 could not confirm allegation to be true. S4, states not working with R1 and S6 states, R1 is not apart of the medication administration program.

Regarding the allegation: staff don’t answer the phone. It’s being alleged that the facility staff does not answer the phone. The investigation revealed the following. R2-6 all state not having an issue with staff not answering the phone. R2 states, the person that’s on the phones is usually very good. R3 states, “as often as I call, they pick up.” R6 states that people congregate at the front sometimes and they may get distracted but they mostly pick up. R1 states not having a phone for the past 6 months. LPA observed R1 make a phone called from their room. S1 states being unaware of the allegation and would need to follow up. S2&3 state they always answer the phone. S4 states there’s no receptionist from 6:30a-7:30a but they do answer the phone during that time. S5 states if no one answers at the front desk then the calls are routed to the kitchen phone. S6 states sometimes they may miss a call if their hands are dirty, but they often pick up.

Regarding the allegation: facility is in disrepair. It’s being alleged that there’s a resident in care without an air conditioning (A/C). The investigation revealed the following. S1 states that central air unit for the room is in need of a “coil.” S1 states due to a shortage on parts and per R1’s request for a “vaccinated technician” repairs have been delayed. S1 states that the facility has place a portable A/C unit in the apartment, and they have offered R1 an alternative room, which was refused. R1 confirms the facility has offered them an alternative room but does not wish to move. R1 confirms receiving a portable A/C unit but wants the unit in the room repaired. LPA toured and interviewed R1 in their bedroom and observed the A/C to be in working order and at a comfortable temperature. R2-R6 state not having any issues with the facility being in disrepair. R4 and R6 both state the carpet could be replaced. R6 states the elevators could be replaced but are in working order. S2-6 did not confirm the facility to be in disrepair. S3 agrees the carpet could be replaced but acknowledged the facility’s efforts in upkeep.

Continued 9099

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210922142330

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: WATERMARK AT BEVERLY HILLS, THE	FACILITY NUMBER: 197609311
	VISIT DATE: 10/20/2021

NARRATIVE

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Regarding the allegation: Staff spoke inappropriate about resident. It’s being alleged that a facility staff member made an inappropriate comment to another staff regarding a resident. R2-6 all state the staff speak to them in an appropriate manner. R2 states, “oh yes, the staff treat me with dignity and respect.” R3 states, “the facility has excellent staff.” R4,5 and 6 state not having any issues with staff and that they are polite. R1 states while just waking up S4 informed them to “cover-up” do to being exposed. R1 states that S4 then told S6 what happened.” S1 states the incident did occur but that S4 mentioned it to S6 as a “form of reporting the incident” and not in a way to embarrass R1. S2-6 all state the residents are spoken to appropriately.

Regarding the allegation: facility not following COVID protocols. It’s being alleged the facility is not screening visitors for covid. R1 states that the “facility opened up too fast.” R1 states the facility does not take temperatures and don’t ask for vaccination cards from visitors. R1 states not leaving their apartment since the beginning of the outbreak. LPA observed the facility to have a screening tool, that measures your temperature and asks questions regarding covid 19 exposure. A vaccination or covid test was requested upon entry. R2-6 all agree the facility follows covid protocols. R2 states yes, they follow protocol sometimes “too much”. R4 state in addition to the facility following protocol they are informed about covid updates via a facility newsletter. S1-6 all acknowledged the covid protocols in place are followed. S3 state they stress the protocols during a monthly associate meeting. S4 states staff and visitors are screened daily. S6 states the facility is very strict surrounding covid.

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An Exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

LIC9099 (FAS) - (06/04)

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