197609311-1-6-2022-11-AS-AJKK-CDQV59-20220422160734

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609311
Report Date: 01/06/2022
Date Signed: 01/06/2022 02:47:42 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
01/05/2022 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220105132343

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: 43	DATE:	01/06/2022
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	Stephanie Walters		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Troy Agard initiated a 10-day complaint investigation for the allegation 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 01/06/2022 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) a work order requesting repairs and 4) email correspondents regarding repairs. Requested documents were received at the time of visit.

On 01/06/2022, LPA Agard delivered findings.

Cont on 9099C

Substantiated

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: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

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-20220105132343

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: 01/06/2022

NARRATIVE

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Regarding the allegation: Facility is in disrepair. It’s being alleged that a resident’s heating, ventilation, and air conditioning (hvac) unit has worked on and off for five years and is only been addressed recently. The investigation revealed the following: During interviews with staff 3 of the 3 confirm there is currently issues, that are being address, with the HVAC system in some units. S1 states being aware of R1’s hvac unit not working properly but states it has since been repaired. “I don’t know about if there were issues for the past five years. The system was repaired yesterday.” S2 states “recently, we have had some issue with the heater. To my knowledge we are getting things repaired and the cooler tower replaced.” S3 states, “things break down. It is common for things to break. They just need to be repaired.”

During interviews with residents, the investigation revealed the following: 3 of the 6 interviewed confirmed the allegation to be true. 2 of the 6 interviewed denied the allegation to be true, and 1 neither confirmed, nor denied the allegation to be true. R1 and R5 state they have both experienced their hvac system not functioning properly and being provided with a portable heater until repairs were done. R4 states not personally experiencing it but has been made aware of it. “It hasn’t been in my apartment, but I have been aware of it and the anger with the residents that its affecting.” R3 and R6 both denied the allegation. R3 states “I find most of the rooms uncomfortably warm. I like the room at 70 and some like the room at 75 or they will complain that it’s too cold.” R6 states, it works but at times I don’t know if it’s the thermostat or me just not regulating it properly, but I get enough heat. R2 states “I don’t remember things being this cold last year. So, I’m not sure it the facility is in disrepair or if we are having a “California Cold Winter.”

During an interview with W1, they confirmed the allegation to be true. “The room has been without proper heating for the past 3 weeks or maybe before that. The heating would go on and off.” During LPA’s review of records, the facility is in the process of having repairs and replacement of the cooler tower completed in the next 6 months that should resolve the facility’s issues with the hvac system.

Based on the investigators interviews conducted with Administrator, staff, resident and review of work order, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22 Division (6) and Chapter (8) are being cited on the attached LIC9099-D.

An exit interview was conducted with caregiver and a hard copy was provided with appeal rights.
See LIC 9009-D on the next page.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220105132343

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/06/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/03/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	Facility will continue to repair HVAC as needed and provide licensing with a plan to replace or repair vital components to ensure HAVC system is working properly for the foreseeable future. This plan of repair(s) or replacement(s) is due by POC due date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on LPA's interview and record review, residents HVAC systems are not operating properly. This poses a potential health, safety or personal rights risk to persons 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: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

LIC9099 (FAS) - (06/04)

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