198320179-4-9-2024-11-AS-EMAZ-D4GQGP-20240419120949

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320179
Report Date: 04/09/2024
Date Signed: 04/09/2024 04:23:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/18/2023 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20230418105343

FACILITY NAME:	SUNRISE OF BEVERLY HILLS		FACILITY NUMBER:	198320179
ADMINISTRATOR:	RITA MELDONIAN		FACILITY TYPE:	740
ADDRESS:	201 NORTH CRESCENT DRIVE		TELEPHONE:	(310) 274-4479
CITY:	BEVERLY HILLS	STATE: CA	ZIP CODE:	90210
CAPACITY:	127	CENSUS: 76	DATE:	04/09/2024
		UNANNOUNCED	TIME BEGAN:	08:54 AM
MET WITH:	Theresa Mack		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff yelled at resident.
Staff did not provide assistance to resident in a timely manner resulting in resident urinating.
Staff forced residents to eat in their bedroom.
Insufficient staffing to escort residents to the dining room.

INVESTIGATION FINDINGS:

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On 04/09/2024, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit to deliver findings regarding the above allegations. LPA Richard met with Director Sales Theresa Mack and Liza Bond Resident Care Director. Later was joined with Assisted Living Coordinator Nancy Maya.

The investigation consisted of the following:
On 04/09/2024, LPA Richard toured the facility inside and out with Director Sales Theresa Mack
LPA Richard reviewed and requested, staff and resident's records, LIC 602, and the daily assignment sheets. LPA interviewed five (R1-R7) Resident, and five staff (S1-S5). LPA Richard requested and reviewed and collected facility documents.

This report is continued, please see LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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-20230418105343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SUNRISE OF BEVERLY HILLS	FACILITY NUMBER: 198320179
	VISIT DATE: 04/09/2024

NARRATIVE

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The investigation revealed the following:

Allegation: “Staff yelled at residents.”

Interviews were conducted with staff (S1-S5) and Residents (R1-R7) and found there’s no evidence to corroborate the allegation mentioned above. During interviews with residents and staff, no one can verify that “Staff yelled at residents”. (R1-R7) have made statements that the staff is very respectful towards residents and have not observed any yelling. (S1-S5) stated that communication with residents is conducted properly. Interviews with Residents (R2, R4) stated that they have had some loud talking in the past with staff due to the residents having a hard time hearing staff when talking to them. However, (R1-R7), stated that some of the residents would yell at the staff when they don’t get what they want. Residents also stated that some of the residents have a hard time hearing the staff, the staff need to speak little bit louder to the residents. Interviews conducted with Residents in Care (R1-R7) stated that staff generally treat residents with respect, and do not yell or raise their voice towards residents. (R1-R7) stated that they have not witnessed staff yelling at other residents. Staff (S1-S5) interview stated that they do not yell at residents. LPA did not observe any staff yell at residents while conducting interviews.

Based on LPA observation, and interviews conducted there is no evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230418105343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SUNRISE OF BEVERLY HILLS	FACILITY NUMBER: 198320179
	VISIT DATE: 04/09/2024

NARRATIVE

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The investigation revealed the following:
Allegation: Staff did not provide assistance to resident in timely manner resulting in resident urinating.
During the interviews with residents (R1-R7) 7 out of 7 residents stated that they were assisted in a timely manner. 4 out of 7 residents stated they have had no issues or concerns with incontinent care and in some cases do not require assistance with daily activities. An interview with (R5) resident stated that staff was available to assist after activating the call button in eight (8) to (10) minutes, sometimes R5 stated that if R5 don’t press call button on time then accident could happen. The resident (R5) stated the staff is very efficient of checking if they need help. The resident (R2-R6) noted that the staff responds promptly when called within (5) to 10 minutes. The Department tested (R7’s) call button on 04/09/24 and observed the equipment to be operable. LPA interviews Staff (S1-S5) stated that residents are monitored every two hours for each shift or as needed when the call button is activated. (S1-S5) stated that for every shift the residents that require assistance and are not independent are being monitored every two hours during each shift and the facility maintains a daily monitoring log for each resident for each shift. Staff (S1-S5) denied having a resident not assisted in resulting in resident urinating. The staff (S1-S5) reported even in the busiest times, the resident is assisted within 8 minutes. The care manager is alerted when a resident activates the call button and the care manager response immediately in the order it was received. The staff (S1-S5) does not recall having not assisting the residents in timely manner resulting in resident urinated on themselves.
Based on the interviews conducted, observation and records review LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230418105343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SUNRISE OF BEVERLY HILLS	FACILITY NUMBER: 198320179
	VISIT DATE: 04/09/2024

NARRATIVE

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The investigation revealed the following:

Allegation: Staff forced resident to eat in their bedroom.

During the interviews with residents (R1-R7), 7 out 7 residents stated that they are not forced to eat in their bedroom. Residents also stated that they most like to stay in their bedroom to watch TV, and they sometimes don’t like going down in the dining room to eat so they asked the caregiver to bring the food to their room. LPA interviews staff (S1-S5), all the staff stated that after they help the resident with their morning routine, they usually asked them if they were coming down to the dining room for breakfast or lunch. The staff stated that the facility allows the residents to come down or stay in their rooms. The assistant coordinator (S1) stated that some of the residents want to be in their room most of the time to eat, watch television, or be on the phone, this is their choice, they have rights we have to obey them. Staff (S1) stated that the facility encourages resident to leave their bedrooms and come to the dining room to eat with other residents.

Based on the interviews conducted, observation and records review LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20230418105343

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SUNRISE OF BEVERLY HILLS	FACILITY NUMBER: 198320179
	VISIT DATE: 04/09/2024

NARRATIVE

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The investigation revealed the following:

Allegation: Insufficient staffing to escort resident to the dining room.

Interviews with Resident’s (R1-R7), seven (7) out of seven (7) stated that they received assistance when needed and the facility have enough staff to assist them. Additionally, six (6) out of seven (7) residents stated that the facility has enough staff to provide care to the residents. During the interview with Staff (S1-S5) 5 out of 5 stated that they could provide care and help resident with daily activities. Additionally, Staff stated there are four (4) staff on duty during the day and evening shift, and four on the night. Depending on the facility census, the facility staffing may fluctuate. Staff (S1-S5) stated that if they needed help to escort the resident to the dining room, they would call other staff from another location to come and assist. Staff (S1-S5) stated that sometimes they are the ones who asked residents if they want to go downstairs to eat in the dining room today. During the time of the visit, LPA observed all resident cares was being met, the residents did not have to wait before they received assistance. LPA reviewed the Staff Roster and observed there are four (4) staff and administrator who work regularly. During the investigation, LPA was unable to find any evidence to support the allegation.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies cited. Exit interview conducted. A copy of this report was provided to Assisted Living coordinator Nancy Maya.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC9099 (FAS) - (06/04)

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