197609314-8-30-2023-11-AS-MVAO-CVEPFP-20230906111704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609314
Report Date: 08/30/2023
Date Signed: 08/30/2023 03:39:49 PM

Unsubstantiated

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
08/24/2023 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20230824143749

FACILITY NAME:	BEIT SHALOM GROUP LLC		FACILITY NUMBER:	197609314
ADMINISTRATOR:	RUDES, MIRIAM		FACILITY TYPE:	740
ADDRESS:	1620 S SHERBOURNE DRIVE		TELEPHONE:	(213) 222-7598
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	6	CENSUS: 6	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Miriam Rudes-Administrator		TIME COMPLETED:	03:39 PM

ALLEGATION(S):

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Staff are not following proper infection precautions with resident in care
Staff made false statements about resident in care
Staff did no report resident's hospitalization to appropriate parties

INVESTIGATION FINDINGS:

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On 8/30/2023 LPA Alfonso Iniguez conducted and unannounced complaint visit. LPA Iniguez meet with Mariam Rudes/Administrator. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted interviews with Resident (R#1-R#3), Administrator(A#1), and Staff (S#1-S#2). Hospice Company (HC), R#1 son (W#1). LPA obtained and reviewed R#1-R#3 Physicians Report, R#1-R#3 Medication Administration Record August 2023, R#1-R#3 Needs and Services Plans, client roster, staff roster, Facility’s emergency plan, facility’s infection control plan, R#4 laboratory test results from 7/31/23, DPH steps on how to handle the spread of scabies, doctor’s orders for prescribed medications(ointment and shampoo), UIR from various dates (5/1/2023-8/29/23), administrator written stamen and facility contact list.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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-20230824143749

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: BEIT SHALOM GROUP LLC	FACILITY NUMBER: 197609314
	VISIT DATE: 08/30/2023

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff are not following proper infection precautions with resident in care.

The details of the complaint alleged that facility staff did not take the appropriate precautions in dealing with an active infection.

During the physical tour, LPA observed (R#4) in quarantine and alone in her room; she is bedridden. The care staff changed her adult diapers and gave her baths in her room. No other resident resides in the room at the moment or since she was diagnosed with the infection. LPA also observed proper infection precautions being taken by the staff; they were wearing disposable gloves and gowns when entering her room and an adequate place to discard them after use. No outside visitors and residents are allowed inside the quarantine area.

During the records review, LPA observed the test results from (R#4); test results were negative or "None seen" on 7/31/23. Also, LPA reviewed the facility's emergency disaster plan for residential care facilities for the elderly and the facility's infection control plan; both plans were submitted on 6/24/22. In addition, LPA reviewed the printout from the Department of Public Health on how to handle the spread of scabies. House doctor (W#3) orders regarding the prescribed ointment and shampoo for all residents and staff.

During an interview with the Administrator, she stated that on 8/18/23, they learned (R#4) was diagnosed with an active case of scabies by a dermatologist. When (R#4) tested positive, they immediately contacted the house doctor and followed his orders. The House doctor prescribed an ointment and shampoo for all residents and staff. The facility and house doctor were in constant communication. In addition, on 8/18/23-8/21/23, the facility contacted LA DPH, but since no one returned their calls, they left voicemails. Since no one from DPH returned their calls, the Administrator stated that they went to the DPH website and followed their instructions on caring for patients with scabies.

During interviews with staff (S#1-S#3), 3 out of 3 stated that the facility follows proper infection precautions, and they are aware of a resident who has an active case of scabies.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230824143749

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: BEIT SHALOM GROUP LLC	FACILITY NUMBER: 197609314
	VISIT DATE: 08/30/2023

NARRATIVE

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During interviews with residents (R#2-R#3), 3 out of 3 stated the facility follows proper infection precautions. In addition, 2 out of 3 stated they are aware of a resident in quarantine with an active case of scabies.

During an interview with the house doctor (W3), he stated that the moment the facility contacted him regarding (R#4) having an active case of scabies, he immediately gave instructions to the facility and prescribed a medical ointment and shampoo for all the residents and staff at the facility. In addition, he stated that the facility administrator and he were in constant communication regarding the active case in the facility. (W3) also stated that (W1) was unhappy with his services, so he found another hospice company and doctor.

During an interview with (W1), he stated that the facility and the staff do not know how to handle proper infection control procedures, and he is looking to relocate his mother to another facility.

During the Interview with the Hospice representative (W2), she stated that on 7/24/23, they ran a test on (R#4) to see if she had an active infection of scabies; the test came back negative or "None saw" on 7/31/2023.

Allegation: Staff made false statements about resident in care.

The details of the complaint alleged that staff stated a resident passed away without being truthful.

During interview with Administrator (A#1), she stated that she has not made false statements in the past regarding the death of a resident in care.

During interviews with staff (S#1-S#3) 3 out of 3 stated that the facility administrator has never made false statements regarding a resident's death.

During interviews with residents (R#1-R#3), 3 out of 3 stated that they don't think the administrator has made false statement about the passing of a resident in care.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230824143749

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: BEIT SHALOM GROUP LLC	FACILITY NUMBER: 197609314
	VISIT DATE: 08/30/2023

NARRATIVE

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Allegation: Staff did no report resident's hospitalization to appropriate parties.

The details of the complaint alleged that the facility sent hospice residents to the hospital without letting the hospice company and family members know.

During interviews with the administrator, Miriam Rudes (A#1), she stated that she has knowledge of hospice services and how hospice functions. “Once a resident is in hospice, they care for everything.” In addition, (A#1) mentioned that she has more than six years of experience dealing with hospice patients and companies. Also, (A#1) stated that she has never sent a hospice patient to the hospital without letting the hospice company or the representative know about it.

During interviews with staff (S#1-S#3), 3 out of 3 stated that the facility knows about hospice services and how it works. Also, 3 out of 3 stated the facility follows the hospice procedures.

During interviews with residents (R#1-R#3), 3 out of 3 residents responded that the facility handles the resident’s medical care properly and they feel the facility will take care of their medical needs properly.

During an interview with the Hospice representative (W2), she stated that on 7/31/23, (W#1) decided to take (R#4) to the hospital. He noted that his mother has scabies. (W#2) advised (W#1) that since (R#4) is under hospice care, the hospice services will be terminated; (W#1) went ahead and took (R#4) to the hospital and hired a new hospice company.

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted, and a copy of the Complaint Report was given to - Luci Setiawan-Caregiver

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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