198603319-9-20-2022-11-AS-UCOL-CL8VTM-20221116154322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 09/20/2022
Date Signed: 09/20/2022 03:27:55 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
09/13/2022 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220913100958

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:	09/20/2022
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Assistant Administrator - Cesilia Torres		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff restrained resident in care.

INVESTIGATION FINDINGS:

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On 09/20/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Assistant Administrator Cesilia Torres.

The investigation consisted of the following: LPA requested service documents and interviewed residents (R1-R8) and staff (S1-S4).

A plant inspection of the facility was conducted.

There were no deficiencies found during any visits.

Investigation revealed:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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-20220913100958

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: 09/20/2022

NARRATIVE

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Allegation: Staff restrained resident in care.

LPA conducted interviews with residents (R1-R8) and there were no concerns with a resident being restrained while in care at the facility. Residents (R1-R7) stated residents (R1-R7) has not witnessed another resident being restrained while in care at the facility. Staff (S1-S4) stated staff (S1-S4) has not witnessed a resident restrained while in care at the facility. Staff (S1-S4) stated staff (S1-S4) has not restrained a resident while in care at the facility. Staff (S1-S4) stated staff (S1-S4) has no concerns with a resident being restrained while in care. During LPA investigation visit, LPA did not observe any residents restrained while in care at the facility. LPA did not observe any restraints on mobility devices during interviews with residents (R1-R8).

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the 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 Cesilia Torres and a hard copy was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC9099 (FAS) - (06/04)

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