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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 05/26/2022
Date Signed: 05/26/2022 02:45:57 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
05/23/2022 and conducted by Evaluator Jade Jordan
COMPLAINT CONTROL NUMBER: 11-AS-20220523161131
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:
05/26/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Bella NaygasTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident was hit while in care.
INVESTIGATION FINDINGS:
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On 05/26/22 Licensing Program Analyst (LPA) Jade Jordan, conducted an unannounced visit regarding allegation(s) above. LPA was met by Facility Administrator Bella Naygas, and the purpose of the visit was explained.

Investigation Consisted of Physical Plant Tour, Staff Interviews, Resident interview, Record Review and copies of Physicians Report/ Needs Services, Staff and Resident Roster.

Regarding Allegation: “Resident was hit while in care.”
On 05/22/22 Reporting party states that Resident (R1) stated to Emergency Room Physician that they were punched/hit chest, at the facility person unknown person. Reporting Party states that C1 was interviewed by Hospital Social Worker and stated that they were punched/hitted in the face, by a black man. Name not known. Report indicates that hospital Social worker and Physician stated that R1 did not have any abnormal bruising on face, or trunk.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jade JordanTELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
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 2
Control Number 11-AS-20220523161131
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: 05/26/2022
NARRATIVE
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Interviews conducted with Administrator, and caregivers generally stated that they have not had any complaints from R1 regarding an assault by anyone in the facility. 3 Staff Stated that R1 often leaves the facility with a friend.

Interviews with R1 Stated that “they are 6’6 and that no one messes with them, and they have not been hit or punched by anyone.”

Interviews with R2-R8 Generally stated they have not witnessed any resident in care being punched or hit at the facility.

Based on LPA observation, interviews and record review The Department Finds “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

An exit interview conducted, copy of this report provided. No citations issued during this visit.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jade JordanTELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2