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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601646
Report Date: 10/30/2022
Date Signed: 10/30/2022 03:20:28 PM

Unsubstantiated


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
08/11/2022 and conducted by Evaluator Ana Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220811123453
FACILITY NAME:BELMONT VILLAGE RANCHO PALOS VERDESFACILITY NUMBER:
198601646
ADMINISTRATOR:LAMM OBERG, RUTHFACILITY TYPE:
740
ADDRESS:5701 CRESTRIDGE RDTELEPHONE:
(310) 377-9977
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY:150CENSUS: 104DATE:
10/30/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Miki Lamm, Executive DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility is not providing adequate food service.
Resident's room is dirty.
Resident is not accorded privacy.
Resident is being overcharged while in care.
Staff cocerced resident.
Staff did not provide resident with records as requested.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Miki Lamm, Executive Director.

The investigation consisted of following: Interviews and Record reviews: On 08/17/22, LPA Soto conducted interviews with the S#1 - Executive Director, S#2 -Nina Khatchatrian - Director of Resident Care Services, S#3 - S#11. On 09/13/22, LPA interviewed R#1 – R#11. The LPA also requested copies of the following documents: Face sheets, Physician's report, Admission report, Care Plan, Hospice file, Private Pall Agreement, Interdisciplinary Progress Notes, Doctor visit short form, Licensed Nurses Notes, Physician's order's, Health care providers communication notes, Assessment notes, POA contract, Revocation of POA, and incident reports for R#1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2022
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 4
Control Number 11-AS-20220811123453
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: BELMONT VILLAGE RANCHO PALOS VERDES
FACILITY NUMBER: 198601646
VISIT DATE: 10/30/2022
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Based on the LPA's investigation, the investigation revealed the following.

Allegation 1 - Resident's hygiene needs are not being met. Interview with Executive director and Director of Care services communicated that R#1 family member is very angry at the fact that family member is no longer R#1 POA. R#1 got a new POA (a fiduciary) and family was very upset. That’s why the family member is making these false accusations against the facility. R#1 has a 1:1 pal and family member was not paying R#1 monthly bill, they were behind. Even though, they rent wasn’t being paid, R#1 was still being taken care of by the 1:1 pal. The 1;1 pal was given R#1 her showers when required. Helping R#1 with combing R#1 hair and changing R#1 diaper. R#1 likes to color coordinate R31 clothes. Now that R#1 has new POA, the facility is getting paid on time for R#1. Interviews with S#2 – S#11, communicated that they always assist all resident with their hygiene needs. They always help them shower, change diapers, clothes them, and anything else they might require. Interviews R#1 – R#11, communicated that the staff gives them all the help they require with their hygiene needs. Staff helps them change their diapers, shower, change clothes, and comb their hair. LPA reviewed R#1 care plan and admission agreement, R#1 is receiving the personal care R#1 is paying for. The interviews conducted and records reviewed did not concur with the above allegation.

Allegation 2 - Facility is not providing adequate food service. Interview with Executive director communicated that R#1 eats very well. R#1 eats in R#1 room. If R#1 doesn’t finish R#1 food R#1 puts it in R#1 fridge and reheats later in the day. R#1 has never complained about the food, R#1 enjoys the food they serve. Interviews with S#2 – S#11, communicated the facility food is good, everyone enjoys the food. The chef cooks a different kind of meal every day. If a resident doesn’t like an item on the menu the chef will prepare what ever the resident request. Interviews with R#1 – R#11, communicated that they like the food. The food has a good taste and they have a variety of food selection. LPA reviewed the facilities menu and it has a variety of different food and they are all nutritional. LPA observed residents dining and they seemed to be enjoying their food. The plates had protein, vegetables, fruit, dairy products, and dessert. The plates looked good and tasty. The interviews conducted, observations and records reviewed did not concur with the above allegation.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20220811123453
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: BELMONT VILLAGE RANCHO PALOS VERDES
FACILITY NUMBER: 198601646
VISIT DATE: 10/30/2022
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Allegation 3 - Resident's room is dirty. Interview with Executive director communicated that the rooms are always cleaned by housekeeping 2 x a week. The private pals pick up room every day. If an accident occurs and they need housekeeping sooner, they just call housekeeping and they come to clean the accident. Interviews with S#2 – S#11, communicated they clean the room every day when they are private pals and they will pick up a resident’s room if they happen to see that they residents room needs it, like picking up their laundry and picking up dishes. Interviews with R#1 – R#11, communicated their rooms are always cleaned. Some clean it themselves and other their pals clean their rooms for them, and housekeeping comes every week to clean their rooms. LPA reviewed the facilities housekeeping schedule they clean rooms 2 x a week. LPA observed the resident’s rooms and they were clean. The interviews conducted, observations and records reviewed did not concur with the above allegation.

Allegation 4 - Resident is not accorded privacy. Interviews with Executive director and S#2 – S#11, communicated they all give privacy to al the residents. If they are private pals they always go to another room and leave them alone to visit with their friends and/or family members. They still are close enough to see and hear if the resident might need them, but they always give them privacy. Interviews with R#1 – R#11, communicated they are always given privacy when they have anyone visiting them. Interviews conducted did not concur with the above allegation.

Allegation 5 - Resident is being overcharged while in care. Interview with Executive Director and S#2, communicated that the residents and their family member are always told the fees they charge, and they decide if they want to have their family member come to the community. If they have an increase in any fee, they are given proper notice of the fee increase. Interview with S#3 – S#11, communicated they do not have any knowledge of how much the resident are being charged. Interviews with R#1 – R#11, communicated they do not take care of their finances, their family does, so they do not know if they are being over charged or not. LPA review the admission agreement for R#1, it showed that the fees were standard for all the services provided. They were not being over charged on their monthly rent. Interviews and records review did not concur with the above allegation.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20220811123453
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: BELMONT VILLAGE RANCHO PALOS VERDES
FACILITY NUMBER: 198601646
VISIT DATE: 10/30/2022
NARRATIVE
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Allegation 6 - Staff coerced resident. Interview with Executive Director and S#2- S#11, communicated the staff has never coerced any resident to do anything they did not want to do. R#1 Family member thinks that the facility told R#1 to change R#1 POA, but the staff does not interfere with any resident’s financial matters. The resident and/or family members decide that for themselves. The staff do not advise or talk about resident’s financial issues. If the residents do talk about it, they only listen, but never advise the residents on anything. The facility only deals with the resident’s care. Interview with R31 – R#11 communicated they have never been coerced by staff to do anything they did not want to do. The staff has always treated with respect. The interviews conducted do not concur with the above allegation.

Allegation 7 - Staff did not provide resident with records as requested. Interviews with Executive director and S#2, communicated that whenever any resident request any records from them, they provided within a reasonable time. Interviews with S#3– S#11, communicated that have no knowledge of residents requesting any records and/or documents from the facility. Interviews with R#1 – R#11, they have never requested records and/or documents from the facility. The interviews conducted did not concur with the above allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated

An exit interview was conducted with Miki Lamm, Executive Director and a hard copy of report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4