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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609311
Report Date: 12/06/2022
Date Signed: 12/06/2022 03:15:01 PM

Unsubstantiated


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
12/02/2022 and conducted by Evaluator Troy Agard
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221202120834
FACILITY NAME:WATERMARK AT BEVERLY HILLS, THEFACILITY NUMBER:
197609311
ADMINISTRATOR:STEPHANIE WALTERSFACILITY TYPE:
740
ADDRESS:220 N CLARK DRIVETELEPHONE:
(310) 860-9234
CITY:BEVERLY HILLSSTATE: CAZIP CODE:
90211
CAPACITY:75CENSUS: 46DATE:
12/06/2022
UNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:David Schupack, interim AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility is in disrepair.
Residents are not being provided adequate food service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Troy Agard conducted an initial investigation for the allegations listed above. LPA met with David Schupack, interim Administrator and explained the purpose of this visit is to gather information regarding the complaint allegations.

The investigation consisted of the following: on 12/06/2022 LPA Agard toured the facility grounds for the main building of the Residential Care Facility for the Elderly (RCFE). The facility has five (5) floors and two underground parking levels. The first floor includes the reception area, dining room, food service area, Administration offices, salon, medication and records room. Also, there is a patio area on the first floor that has tables and chairs for resident’s use, along with common bathrooms. The facility also has 60 resident bedrooms, and 60 resident bathrooms. Each floor has a common laundry room, a common restroom. Each floor has a different activity room except the 3rd floor which has a guest suite. LPA requested copies of the following: 1) a copy of the resident roster, 2) copy of the staff roster. Requested documents were received at the time of visit. LPA Agard delivered findings.
Cont. on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
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-20221202120834
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: 12/06/2022
NARRATIVE
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The investigation revealed the following… regarding the allegation: Facility is in disrepair. “It’s being alleged the left side of the building was leaking in rooms, hallways and the roof from the rain and from a busted pipe. It is unknown if the facility will be getting help to clean up.” LPA interviewed 4 out of a total of 46 residents. 1 out of 4 confirmed the allegation. All residents confirm there has been a leak due to a ruptured pipe but generally deny the facility is in disrepair. R1 states, “the facility is generally in good shape.” R2 states, “I would say in general the facility is not in disrepair.” R3 states, “the facility is fine. There isn’t really much repair issues.” R4 states, “I feel like the building is poorly ran. They don’t patch things up the way they are suppose too.”

During interviews with staff, LPA interviewed 4 out of a total of 40. 0 out of 4 confirmed the allegation. All interviewees acknowledged the flood cause by a ruptured pipe but denies the facility is in disrepair. S1 states, “I would say no, nothing uncommon for a building of this size.” S2 states, “I disagree. Plus, my area was okay, so we continued our day as normal.” S4 states, “there are some cosmetic issues that can be addressed but not anything that is in disrepair.”

Regarding the allegation: Residents are not being provided adequate food service. “It’s being alleged because staff are cleaning up the facility, residents are not being provided meals on time or at all.” 0 out of 4 confirmed the allegation. R1 states, “I got my meals. I got it on time as I recall.” R2 states, “I have been getting my meals regularly. I haven’t had any issues with my food orders due to this flood.” “R3 states, “there were absolutely no issues with my food, and we have been having deliveries, too. There have been no issues.” R4 states, “no issues with my food and getting it on time.”

During interviews with staff, 0 out of 4 confirmed the allegation. S1 states, “that’s out of my area. Not sure about that.” S2 states, “all the residents received their meals. We delivered and some of them came down to dine.” S3 states, “I’m not aware of that. I want to say all the residents did actually eat.” S4 states, “when I’ve come here each time; the residents were eating like they would normally. There were no alternative planned diets.”



During facility tour, LPA observed that a flood did occur but has not reach a level of disrepair or unhabitable. LPA Agard observed a restoration team onsite addressing the water damage caused by a broken pipe to a
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20221202120834
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: 12/06/2022
NARRATIVE
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vacant unit and the common areas. LPA observed dehumidifiers in the hallways of each floor but not obstructing the walking paths. LPA observed some baseboards removed where hot air was being blown to extract any additional moisture but again not obstructing any walkways.

Based on LPA’s observation, and interviews conducted, 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 did or did not occur, therefore the allegation(s) are unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3