198601646-9-9-2022-11-AS-JHAD-CJXPZ8-20221006114509

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601646
Report Date: 09/07/2022
Date Signed: 09/09/2022 08:12:18 AM

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
09/06/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220906123845

FACILITY NAME:	BELMONT VILLAGE RANCHO PALOS VERDES		FACILITY NUMBER:	198601646
ADMINISTRATOR:	LAMM OBERG, RUTH		FACILITY TYPE:	740
ADDRESS:	5701 CRESTRIDGE RD		TELEPHONE:	(310) 377-9977
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	150	CENSUS: 115	DATE:	09/07/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Miki Lamm, Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not provide comfortable accommodations to the residents while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted an initial complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Miki Lamm, Executive Director.

The investigation consisted of following: Interviews and Record reviews. On 09/06/22, LPA Soto interviewed Executive Director, S#2 - S#10, R#1 - R#11. LPA received the following document on 09/03/20: Resident Roster, and Staff Schedule. LPA toured the entire facility. Visited rooms 208, 216, 247, 304, 308, 323, 326, 334, 336, 347,348, and 352. LPA also toured (cafeteria/dining room), nursing station, lobby,and lounge for lounge/ library area 2nd floor, all hallways on 1st floor, 2nd floor and 3rd floor. The hair salon and gym on the 3rd floor.

Based on the LPA's investigation, the investigation revealed the following. Allegation – Staff do not provide comfortable accommodations to the residents while in care. According to RP the A/C was not working in certain areas of the facility such as: nursing station, hallways, and cafeteria.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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-20220906123845

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: 09/07/2022

NARRATIVE

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LPA observed that the main A/C unit was working on all the common areas of the facility. The temperature for all 3 floors in the common areas was at a comfortable temperature. The residents have their own individual PTAC (A/C) unit in their rooms. Residents can control their own PTAC unit. They can turn it on and off, also can turn temperature up or down. Interviews with the resident and staff all agreed that the A/C unit and PTAC units have been working and the facility and residents rooms are at a comfortable temperature. The interviews and observations did not concur with the above allegation.

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

An exit interview was conducted with Miki Lamm, Executive Director, and a hard copy of report was provided via email due technical difficulties (printer not working)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC9099 (FAS) - (06/04)

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