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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204545
Report Date: 10/16/2020
Date Signed: 10/16/2020 05:12:22 PM



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
06/12/2020 and conducted by Evaluator Martessa Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20200612115420
FACILITY NAME:SIMLA VILLAS, REDONDO BEACHFACILITY NUMBER:
198204545
ADMINISTRATOR:SIMLA MEHTAFACILITY TYPE:
740
ADDRESS:2805 ROBINSON STREETTELEPHONE:
(310) 483-6964
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90278
CAPACITY:6CENSUS: DATE:
10/16/2020
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Simla Mehta, AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility did not post their license number on advertisement
INVESTIGATION FINDINGS:
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On 10/16/20 at 1:00 PM, Licensing Program Analyst (LPA) Martessa Brown conducted a subsequent visit in order to render investigation findings for the above allegations. Due to the situation surrounding the coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation findings was conducted telephonically with Simla Mehta, the facility administrator and the purpose of the visit was explained.

The investigation consisted of the following: On 6/19//20, regarding the above allegation, LPA Brown conducted a google search under the facility's name and the license number was not listed anywhere on the website. LPA met with Simla Mehta, facility Administrator. During the visit LPA conducted a video telephone visit that consisted of viewing the physical plant entire facility. LPA interviewed the administrator regarding the complaint.
The investigation revealed the following:

9099-C is on the next page

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2020
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-20200612115420
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: SIMLA VILLAS, REDONDO BEACH
FACILITY NUMBER: 198204545
VISIT DATE: 10/16/2020
NARRATIVE
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Facility did not post their license number on advertisement: LPA interviewed administrator on 6/19/20 over the telephone regarding the above allegation at 11:30 am. Administrator stated she was not aware that her website advertisement did not display the facility license number. She stated they had just recently updated and website and had forgot to add the license number. She stated i will make the change to the website to reflect the number.

Substantiated: Based on LPA's observations and interview with the administrator which were conducted, 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.

Exit Interview Conducted, appeal rights were explained and a copy of this report was furnished to Licensee.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20200612115420
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: SIMLA VILLAS, REDONDO BEACH
FACILITY NUMBER: 198204545
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2020
Section Cited
CCR
87206(a)
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87206(a) Advertisements and License Number
Each residential care facility for the elderly licensed under this chapter shall reveal its license number in all advertisements...

This requirement was not met as evidenced by:
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Licensee will make the correction to display the license number on the website for advertisement.
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Based on LPA's observation and interview conducted, Licensee did not ensure facility license number was displayed on website for advertisement.

This possess a potential health and safety risk to residents in care.
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The administrator had made the correction and the license number is now displayed on the website.
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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.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3