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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 02/17/2022
Date Signed: 02/17/2022 04:33:30 PM



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
02/11/2022 and conducted by Evaluator Martessa Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220211093906
FACILITY NAME:BEVERLY HILLS TERRACEFACILITY NUMBER:
198603319
ADMINISTRATOR:STRIKS, AHARONFACILITY TYPE:
740
ADDRESS:1470 S ROBERTSON BLVDTELEPHONE:
(310) 273-3668
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:110CENSUS: 72DATE:
02/17/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Bella Naygas and Cesilia TorresTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not preventing the spread of COVID-19.
Facility is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 2/17/2022, Licensing Program Analyst (LPA) Martessa Brown and (LPM) Janae Hammond conducted a subsequent complaint visit in order to render investigation findings. During today’s visit LPA met with Bella Naygas the Administrator ad Cesilia Torres Assistant Administrator and the purpose of the visit was explained.

The investigation consisted of the following: on 2/17/2022, LPA and LPM toured the physical plants. LPA observed on the 1st floor elevator southside of the building was not working. LPA conducted interviews with the Administrator, staff #2-4 and residents #1-7. LPA/LPM obtained the following documents: Resident/Staff Roster and elevator company contract/invoice completion.

The investigation revealed the following:

Regarding allegation: Facility does not properly screen for COVID-19.

LIC 9099-C is on the next page




Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
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 5
Control Number 11-AS-20220211093906
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: BEVERLY HILLS TERRACE
FACILITY NUMBER: 198603319
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2022
Section Cited
CCR
87468.1(2)
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in All Facilities
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
Administrator will review Covid-19 provider pins information notice and implement Covid-19 proper screen procedure and review their Mitigation Plan. Administrator will also come up with a plan on how they will maintain proper screening of visitors and staff to LPA by POC due date.
8
9
10
11
12
13
14
Based on LPA/LPM's observation, screening but did not observe any hand sanitizer, mask or screen log in place and there is not designated staff in charge of screening visitors. LPA did not observe a screening log in place.
This poses a potential health and safety risk to all residents in care.
8
9
10
11
12
13
14
Type B
02/24/2022
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
Administrator will make sure elevator is in good condition and working at all times. Administrator will submit a plan on how they will ensure that the residents health and safety are met in the event if the elevator is down. Administrator will provide proof that the elevator is working to LPA by POC due date.
8
9
10
11
12
13
14
Based on observation and interviews conducted, Licensee did not ensure elevator was accessible to residents in care. Elevator has been in not operating since 08/2021.

This poses a potential health and safety risk to all residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20220211093906
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: BEVERLY HILLS TERRACE
FACILITY NUMBER: 198603319
VISIT DATE: 02/17/2022
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
It is alleged that facility failed to properly screen visitors for Covid-19 On 2/17/22 LPA interviewed Bells Naygas regarding the allegation and she stated they do not have visitors except for doctors, nurses and licensing. She stated when visitors sign they check their temperatures. Administrator also stated they do not screen visitors and do not ask screening questions. On 2/17/22, LPA conducted interviewed staff #2-4 and they stated do not ask screening questions and have not observed other staff asking questions. LPA interviewed residents #1-7, they stated staff doesn't take there temperatures when they enter from outside the facility. When LPA and LPM arrived at the facility, they did check our temperature but did not observe any hand sanitizer , mask or screen log in place and there is not designated staff in charge of screening visitors. Based on LPAs observation the facility failed to comply with covid-19 procedure as identified Pin 21-38-ASC. and Pin 22-07-ASC.

Regarding allegation: Facility is in disrepair.



On 2/17/22, LPA conducted interview the Administrator, she stated the elevator has not been in operation since 8/2021 due to not having a part. She stated Non-Ambulatory residents have been moved to the first floor for accommodations. She stated the elevator will be working on 2/21/22. LPA conducted interviews with staff #2-4. Staff stated the elevator has been down for a while. Staff also stated they have not noticed any residents on the 2nd floor having difficulty going down the stairs due to the elevator not working. on 2/17/22, LPA interview residents #1-7 and they stated the elevator has not been working since 08/2021. Resident #7 stated they heard someone had fell down the stairs a few months ago. On 2/17/22, LPA obtained elevator repair receipts. Based on LPAs observation the facility failed to comply with the operations of the elevator.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099-D.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
02/11/2022 and conducted by Evaluator Martessa Brown
COMPLAINT CONTROL NUMBER: 11-AS-20220211093906

FACILITY NAME:BEVERLY HILLS TERRACEFACILITY NUMBER:
198603319
ADMINISTRATOR:STRIKS, AHARONFACILITY TYPE:
740
ADDRESS:1470 S ROBERTSON BLVDTELEPHONE:
(310) 273-3668
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:110CENSUS: 72DATE:
02/17/2022
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Bella Naygas and Cesilia TorresTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is unkept
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 2/17/2022, Licensing Program Analyst (LPA) Martessa Brown and (LPM) Janae Hammond conducted a subsequent complaint visit in order to render investigation findings. During today’s visit LPA met with Bella Naygas the Administrator ad Cesilia Torres Assistant Administrator and the purpose of the visit was explained.

The investigation consisted of the following: on 2/17/2022, LPA and LPM toured the physical plants. LPA observed on the 1st floor elevator southside of the building was not working. LPA conducted interviews with the Administrator, staff #2-4 and residents #1-7. LPA/LPM obtained the following documents: Resident/Staff Roster and elevator company contract/invoice completion.

The investigation revealed the following:

Regarding the allegation: Facility is unkept
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20220211093906
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: BEVERLY HILLS TERRACE
FACILITY NUMBER: 198603319
VISIT DATE: 02/17/2022
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
It is alleged that facility is not clean. On 2/17/22, LPA interviewed the administrator and she stated facility is deep clean once a week and spot cleaned daily. She stated no residents had any concerns. LPA interview staff #2-4, all residents stated the facility is deep clean once a week and spot cleaned daily. LPA Interview residents #1-7 and all residents stated the facility is deep clean once a week and spot cleaned daily. LPA/LPM walked through the facility and there was no trash left out and the facility was clean.

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.

Exit interview was conducted and a hard copy was provided via email for signature.


SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5