198320323-5-6-2026-11-AS-UCOL-DVLL2V-20260702082259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320323
Report Date: 05/06/2026
Date Signed: 05/06/2026 04:16:43 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
04/27/2026 and conducted by Evaluator Jose Anguiano

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260427141713

FACILITY NAME:	BEIT SHALOM		FACILITY NUMBER:	198320323
ADMINISTRATOR:	NAHUM, EILAT		FACILITY TYPE:	740
ADDRESS:	3121 CASTLE HEIGHTS AVE		TELEPHONE:	(310) 309-0405
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	6	CENSUS: 6	DATE:	05/06/2026
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Shimon Bayar		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility will not release resident records to authorized representative.
Staff physically abused resident in care.

INVESTIGATION FINDINGS:

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On 05/06/2026, Licensing Program Analyst (LPA) Jose Anguiano conducted a complaint investigation visit at the facility and met with Administrator Shimon Bayar.
The investigation consisted of the following:
The Department interviewed four (4) staff members (S1-S4), interviewed five (5) residents (R1-R5), interviewed Witness (W1), conducted observations of the facility environment, and reviewed records including LIC 601, LIC 602, Admission Agreement, Durable Power of Attorney for Health Care, Medication Administration Records (MARs), daily care flow sheets, internal facility notes, and text message communications between the facility and resident representative.
The investigation revealed the following:
Regarding the allegation, “Facility will not release resident records to authorized representative,” it was alleged that the facility failed to provide requested resident-related information to (W1).
Please see rerport continuation on (LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

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-20260427141713

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: BEIT SHALOM	FACILITY NUMBER: 198320323
	VISIT DATE: 05/06/2026

NARRATIVE

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Interview with (W1) revealed that on or about 04/05/2026, (W1) requested resident-related information from the facility and stated concerns regarding incomplete information. Interviews conducted during the investigation, along with records reviewed, revealed ongoing communication and coordination between the facility and the resident representative. Interview with staff (S1) revealed that the facility received Power of Attorney documentation for resident (R1) in approximately early April 2026 and collaborated with the resident representative regarding resident medications, hospice-related information, physician coordination, and resident care needs. Interview with staff (S4) revealed that requests for records were referred to administration for review and processing. Review of facility records, internal notes, and text message communications revealed ongoing communication and coordination between the facility and (W1) regarding resident care, medical providers, medications, and resident preferences. Based on interviews conducted, and records reviewed made during the investigation, the Department did not find sufficient evidence to support that the facility intentionally refused to provide resident records or medical-related information to the authorized representative. Therefore, the allegation is unsubstantiated.
Regarding the allegation, “Staff physically abused resident during care,” it was alleged that facility staff handled resident (R1) inappropriately during care assistance. Interviews conducted with residents (R2-R5) revealed that residents reported feeling safe in the facility and denied observing staff physically mistreat residents. Interview with resident (R1) revealed that (R1) denied staff handling resident (R1) inappropriately. During the interview, (R1) appeared emotional and had difficulty clearly recalling or explaining certain events and care concerns. Interviews conducted with staff (S1-S4) revealed that resident (R1) occasionally resisted care and redirection during shower assistance. Record review revealed resident (R1) had cognitive and medical conditions requiring supervision and assistance with activities of daily living. Review of MARs, daily care records, internal facility notes, and text message communications revealed ongoing staff assistance with resident care, showering, medication administration, and behavioral redirection.
Based on interviews conducted, records reviewed, and observations made during the investigation, the Department did not find sufficient evidence to support the allegation that facility staff physically abused resident (R1). Therefore, the allegation is unsubstantiated. No deficiencies were cited at this time. No deficiencies were cited during today’s visit.

An exit interview was conducted with the administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

LIC9099 (FAS) - (06/04)

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