198603319-9-29-2022-11-AS-MVAO-CKDQ2T-20221020114741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 09/29/2022
Date Signed: 09/29/2022 03:07:05 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
09/23/2022 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220923105235

FACILITY NAME:	BEVERLY HILLS TERRACE		FACILITY NUMBER:	198603319
ADMINISTRATOR:	STRIKS, AHARON		FACILITY TYPE:	740
ADDRESS:	1470 S ROBERTSON BLVD		TELEPHONE:	(310) 273-3668
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	110	CENSUS: 72	DATE:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Assistant Administrator Cesilia Torres/Administrator Ella Naygas		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff refuse to follow up on the cockroach infestation at the facility.

INVESTIGATION FINDINGS:

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On 09/29/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Assistant Administrator Cesilia Torres and Administrator Ella Naygas.

The investigation consisted of the following: LPA requested service documents and interviewed residents (R1-R9), Administrator, staff (S1-S7) and witness (W1).

A plant inspection of the facility was conducted.

Investigation revealed:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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-20220923105235

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS TERRACE	FACILITY NUMBER: 198603319
	VISIT DATE: 09/29/2022

NARRATIVE

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Allegation: Facility staff refuse to follow up on the cockroach infestation at the facility.

LPA interviewed residents (R1-R9). The majority of the residents have not witnessed issues with cockroaches at the facility. The majority of the residents stated there is no concern with an infestation of cockroaches at the facility. LPA interviewed the Administrator who stated there is no issue with cockroaches at the facility. LPA interviewed staff (S1-S7). The majority of the staff have not witnessed issues with cockroaches at the facility. The majority of the staff stated there is no concern with an infestation of cockroaches at the facility.

LPA obtained a service agreement with pest control company (W1). LPA interviewed witness (W1) who stated the service agreement with the facility was signed on 11/10/2020. Witness (W1) stated the service agreement is ongoing and the facility is serviced on the 4^th Tuesday of every month. LPA obtained copy of the invoice for the most recent service completed on 09/27/2022. LPA did not observe an infestation of cockroaches at the facility during the visit.

There is no evidence to support the allegation above that the facility staff refuse to follow up on the cockroach infestation at the facility.

Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated

There were no deficiencies found at the time of the visit.

An exit interview was conducted with Assistant Administrator Cesilia Torres and a hard copy was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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