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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610319
Report Date: 06/13/2025
Date Signed: 06/13/2025 02:35:00 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
06/05/2025 and conducted by Evaluator Raymond Comer
COMPLAINT CONTROL NUMBER: 31-AS-20250605102838
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: 61DATE:
06/13/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Irma RoblesTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff do not ensure smoke detectors are operating properly-
INVESTIGATION FINDINGS:
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Today, Friday, 6/13/25, at 10:40 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannuouned, initial10- day visit to investigate the above allegation. LPA met with Assistant Administrator, Irma Robles, presented official CDSS badge identification, and reason for the visit was disclosed.

To investigate this allegation, LPA received facility resident roster, and staff roster. From 10:50 am to 11:40 am, LPA conducted a tour of the faciliy and interviews with staff.

Allegation: Staff do not ensure smoke detectors are operating properly- Reporting Party (RP) states hearing "chirping" sounds coming from the facility, which suggests smoke detectors signaling either "low battery" status, or a malfunction.

(LIC 9099C)-Continued

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
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 31-AS-20250605102838
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BEL AIR GUEST HOME
FACILITY NUMBER: 197610319
VISIT DATE: 06/13/2025
NARRATIVE
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LPA spoke with the assistant Administrator, and conducted a tour of the facility, which revealed the following: all smoke detectors in resident bedrooms are battery powered. Smoke detectors in resident bedrooms #20, #21, and #30 were observed indicating "low battery" status. Batteries were replaced and all effected smoke detectors are now functioning properly. Fire alarm/fire sprinkler system was tested on 6/04/25 by testing agency, Z&S Fire Equipment; All test results show as PASSED. Fire panel displays "NORMAL" status, showing no system trouble codes. LPA activated smoke detectors in random resident rooms and observed them as working properly.

Based upon LPA observation, this allegation is deemed Substantiated. However, effected facility smoke detectors now appear to be operating properly. Deficiency cited on LIC9099 D.

Exit Interview conducted, report provided, and appeal rights explained.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250605102838
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEL AIR GUEST HOME
FACILITY NUMBER: 197610319
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2025
Section Cited
CCR
80087(a)
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80087(a) Buildings and Grounds- The facility shall be clean, safe, sanitary and in good repair at all times....This requirement was not met as evidenced by:
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POC is cleared during today's visit. Batteries in effected smoke dectector were replaced; devices now functioning properly. Moving forward, licensee shall conduct weekly maintenance checks of all resident rooms to ensure compliance.
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Based on LPA observation, Smoke detetors, located in three (3) resident bedrooms, indicated "low battery" condition, which presents a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3