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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320319
Report Date: 02/08/2024
Date Signed: 02/08/2024 01:56:39 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
02/01/2024 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240201131654
FACILITY NAME:BEVERLY HILLS HOMEFACILITY NUMBER:
198320319
ADMINISTRATOR:GHODSIAN, SHAROUZFACILITY TYPE:
772
ADDRESS:450 SOUTH LA PEER DRIVETELEPHONE:
(310) 709-7355
CITY:BEVERLY HILLSSTATE: CAZIP CODE:
90211
CAPACITY:6CENSUS: 0DATE:
02/08/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Sharouz GhodsianTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Facility is over capacity.
Facility staff are not meeting the needs of the residents.
Licensee made unpermitted alterations to the physical plant.
Mattresses are unsanitary.
INVESTIGATION FINDINGS:
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On 12/08/24, at 09:50am, Licensing Program Analyst (LPA) Perry Scott initiated a 10-Day complaint investigation regarding the allegations listed above. LPA met with Sharouz Ghodsian, Administrator (S1), and explained the purpose of today’s visit.

On 02/08/24, the investigation consisted of the following:

During today’s visit LPA toured the facility. LPA requested the following records: Resident roster, staff roster, and any documents for therapeutic services for the clients. LPA was advised by the administrator (S1) that the facility does not have any staff nor clients, therefore does not have any documents. LPA interviewed staff (S1).

The investigation revealed the following- Allegation # 1 Facility is over capacity.

Report Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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-20240201131654
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: BEVERLY HILLS HOME
FACILITY NUMBER: 198320319
VISIT DATE: 02/08/2024
NARRATIVE
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On 02/08/24, at 12:00pm LPA interviewed (S1). It is alleged that the facility is serving more clients than the capacity for which it is licensed for, which is a total of six (6) ambulatory clients. 1 of 1 staff denied the allegation that the Facility is over capacity. S1 stated that they are not operating over capacity because the facility does not have any clients nor staff at present and have not had any since the facility opened. LPA toured the facility and did not find any evidence of clients or staff living in the facility. LPA also checked the facility records and did not find any evidence of client records nor staff records. LPA did not interview other staff or clients because there were none.

Based on interviews, records reviewed, and observations, there is insufficient evidence to support the allegation that the Facility is over capacity. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation # 2 Facility staff are not meeting the needs of the residents.

On 02/08/24, at 12:00pm, LPA interviewed (S1). It is alleged that the staff are not offering client services nor cleaning and sanitizing the facility and admitting other clients to come from another facility to stay overnight thereby causing the current clients to be inconvenienced. 1 of 1 staff denied the allegation that the Facility staff are not meeting the needs of the residents. S1 stated that the facility does not have any clients or staff and have not transferred any staff from another facility. LPA toured the facility and did a records review and did not find any evidence of clients nor staff having worked there. LPA did not interview other staff or clients because there were none.

Based on interviews, observation, and a records review there is insufficient evidence to support the allegation that the Facility staff are not meeting the needs of the residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20240201131654
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: BEVERLY HILLS HOME
FACILITY NUMBER: 198320319
VISIT DATE: 02/08/2024
NARRATIVE
1
2
3
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5
6
7
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Allegation # 3 Licensee made unpermitted alterations to the physical plant

On 02/08/24, at 12:00pm, LPA interviewed S1. It is alleged that the facility has added an extra bedroom to the facility. 1 of 1 staff denied the allegation that the Licensee made unpermitted alterations to the physical plant. S1 stated that no changes or alterations have been made to the home. LPA toured the facility. During the tour LPA verified the facility against the fire inspection report and the original facility sketch and did not find any evidence that the facility had made any unpermitted alterations to the facility. The facility consists of the following: Three (3) bedrooms (2 beds per room), living room, dining room, kitchen, laundry room, med room, carport, back yard, and three (3) bathrooms. LPA did not interview other staff or clients because there were none.

Based on interviews, there is insufficient evidence to support the allegation that Licensee made unpermitted alterations to the physical plant. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation # 4 Mattresses are unsanitary.

On 02/08/24, at 12:00pm, LPA interviewed S1. It is alleged that the facilities mattresses are dirty, and urine stained.1 of 1 staff denied the allegation that the Mattresses are unsanitary. S1 stated the mattresses are brand new and are not dirty or urine stained. During a tour of the facility LPA observed all six (6) mattresses in the facility and noted that they were not dirty no urine stained. LPA did not interview other staff or clients because there were none.

Based on interviews, and observations there is insufficient evidence to support the allegation that the Mattresses are unsanitary. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were cited during today’s visit.

An exit interview was conducted, and a copy of this report was given to Sharouz Ghodsian, Administrator.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3