<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601646
Report Date: 10/30/2022
Date Signed: 10/30/2022 02:19:09 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
09/08/2022 and conducted by Evaluator Ana Soto
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220908110929
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:
03:00 PM
MET WITH:Miki Lamm, Executive DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff disconnected resident’s telephone
Staff over medicated resident
Staff restricting visitation to resident
Staff restricting phone calls to resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 09/13/22, LPA Soto conducted interviews with Nina, Director of Care Services, S#2, & S#3, and R#1 - R#11. Interviewed Staff #4 - S#7 via telephone. LPA also requested copies of the following documents: Facility Menu, Mars (August and September) and Admission Agreement for R#1.

Based on the LPA's investigation, the investigation revealed the following.
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 3
Control Number 11-AS-20220908110929
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation 1 – Staff disconnected resident’s telephone. Interview conducted with Director of Care Services, communicated that R#1 family member is upset that they are not R#1 POA. They are just trying to create problems for the facility. R#1 has their own phone in their room. The phone line has never been disconnected. The pals would have advised management if the phone line had gone dead. Interviews with S#2 – S#7, they communicated that R#1 phone has never been disconnected as far as they know. If the phone line would have been disconnected the private pal or R#1 would have told management about it. R#1 uses the phone to call R#1 friends all the time, R#1 would have noticed if R#1’s phone line would have been disconnected. R#2 – R#11, communicated that they have their own cell phone, so they would know if the facilities phone has ever been disconnected. LPA observed that R#1 has their own line land, and it had a dial tone when LPA picked it up to see if land line was working. The observations and interviews did not concur with the above allegation.

Allegation 2 - Staff over medicated resident. Interviews conducted with Director of Care Services, RN, and S#3 - LVN, communicated that R#1 has always received their medication on time. They have never missed a dose or overmedicated R#1. R#1 receives their medication as indicated by doctor’s orders. They have never over medicated R#1 or any other resident. Interviews with R#1 – R#11, communicated that their medication has always been given right and never been overmedicated. LPA reviewed Mars (August and September,) the medication has given and prescribed by doctor, the staff indicated on every entry for everyday medication morning, afternoon, evening and at bedtime medication had been given. The records reviews and interviews conducted did not concur with the above allegation.

Allegation 3 - Staff restricting visitation to resident. Interview conducted with Director of Care Services, communicated that R#1 family member came once to visit R#1 and has never come back to visit R#1. The one-time the family member came over to visit, family member was complaining about everything. Family member was just mad about not being the POA anymore. Interviews with S#2 – S#7, they communicated that R#1 always has a specific visitor that comes all the time to visit R#1, R#1 enjoys their company. Family member only came once and R#1 doesn’t like to see family member. Interview with R#1 communicated that R#1 doesn’t have anything to do with family member. R#1 doesn’t like family member and never had a relationship with family member. R#1 doesn’t know why family member calls R#1 and R#1 hasn’t seen family member in years and likes it like that. R#2 – R#11, communicated that they are always allowed to have visitor’s, facility never restricts their visitors. Interviews conducted 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 3
Control Number 11-AS-20220908110929
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
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation 4 - Staff restricting phone calls to resident. Interview conducted with Director of Care Services, communicated R#1 pal answers the phone and will tell R#1 who’s on the phone and then asks R#1 is R#1 wants to speak to whomever is on the phone. R#1 makes their own decision on who R#1 will talk to. Every time R#1 family member calls R#1 refuses to talk to family member. R#1 is cognitive enough to say who R#1 will speak to and who R#1 won’t speak to. Family member called the concierge and yelled and screamed at them, claiming that the facility is refusing to give R#1 the call, the facility can’t and won’t ever deny any phone calls R#1 or any other resident. Interviews with S#2 – S#7, they communicated that most residents have their own cell phone and/or land lines, so they get all their calls. R#1 has their own landline, the private pals that assist R#1 answer the phone and/or R#1 answer and R#1 can listen to R#1 answering machine. R#1 always tells pals that R#1 doesn’t want to talk to R#1 family member. R#1 always saying family member wants to take R#1 money. Interviews with R#1 communicated that R#1 doesn’t have anything to do with family member. R#1 doesn’t like family member and never had a relationship with family member. R#1 doesn’t know why family member calls R#1. R#1 hasn’t seen family member in years and likes it like that. R#2 – R#11, communicated that they have their own phone and the facility doesn’t interfere with their phone calls. The facility never bothers them about any phone calls. LPA observed that R#1 has their own line land, so, the facility has no control over resident’s calls. The observations and interviews 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: 3 of 3