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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610319
Report Date: 07/03/2023
Date Signed: 07/03/2023 02:38:08 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/23/2023 and conducted by Evaluator LaQueena Lacy
COMPLAINT CONTROL NUMBER: 31-AS-20230123110205
FACILITY NAME:BEL AIR GUEST HOMEFACILITY NUMBER:
197610319
ADMINISTRATOR:SAMUEL, GALINAFACILITY TYPE:
735
ADDRESS:1440 N. STANLEY AVENUETELEPHONE:
(323) 876-3370
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:65CENSUS: 62DATE:
07/03/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Galina SamuelTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Facility staff not supervising resident causing resident to threaten by standers.

Facility has pests around the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) LaQueena Lacy arrive at 2:00pm, to conduct an unannounced subsequent complaint visit to deliver findings on 07/03/2023. Upon arrival LPA LaQueena Lacy met administrator Galina Samuel and explained the purpose of this visit.

1. Facility staff not supervising resident causing resident to threaten by standers.

It is alleged that a male resident is threatening and cursing at neighbors, by standers and children. To investigate the above allegation, LPA requested and obtained copies of facility files and documents including but not limited to the staff and resident rosters. On 02/02/2023 LPA interviewed the Administrator and assistant Administrator at approximately 11:24am between 11:49am and resident and additional staff at approximately 2:05pm between 3:02pm. Interviews with six (06) out of (06) residents confirm they have not witnessed any resident threatening any neighbors, by-standers, children, or other residents and have not witnessed them being yelled or screamed at.
Continued on 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
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 2
Control Number 31-AS-20230123110205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BEL AIR GUEST HOME
FACILITY NUMBER: 197610319
VISIT DATE: 07/03/2023
NARRATIVE
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They confirm that staff is available to assist when they need assistance, and their needs are being met. During the investigation, it was revealed that resident #1 (R1) experienced a mental health crisis and was seeking medical treatment for their condition. Upon record review of R1s discharge and after care plan from Glendale Hospital, R1 began seeking treatment on 12/16/2022 and was discharged on 01/10/2023. R1 began additional treatment with LA Downtown Medical Center (LADMC) on 01/13/2023. Based on interviews, observations and record review, there is not enough corroborating evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

2. Facility has pests around the facility.

It is alleged that residents are not throwing away their trash causing rats around the facility. Interviews with (06) out of (06) residents on 02/02/2023 at approximately 2:05pm between 3:02pm confirm they have not seen any rats at the facility or in their bedrooms, and staff keep the facility grounds clean by sweeping and picking up trash every day. During the investigation LPA inspected the storage room at the back of the building where cleaning supplies, brooms and mop buckets are kept, no rats or pest were observed. LPA inspected two (02) storage closest (1st & 2nd floor) where the facility keeps extra towels, linens, and trash bags, no rats or pest were observed. LPA observed 6 random bedrooms and did not observe any rats or pest. Based on interviews, and observations there is not enough corroborating evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards are noted during this visit.

No deficiencies cited. Exit interview conducted and copy of report and appeal rights issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2