198603319-4-6-2021-11-AS-MVAO-C3NLVX-20210604090617

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 04/02/2021
Date Signed: 04/06/2021 10:07:20 AM

Substantiated

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
03/16/2021 and conducted by Evaluator Martessa Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210316154508

FACILITY NAME:	BEVERLY HILLS TERRACE		FACILITY NUMBER:	198603319
ADMINISTRATOR:	STRIKS, AHARON		FACILITY TYPE:	740
ADDRESS:	1470 S ROBERTSON BLVD		TELEPHONE:	(818) 293-2007
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	110	CENSUS: 80	DATE:	04/02/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	AHARON STRIKS		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Illegal Eviciton

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Martessa Brown conducted a subsequent visit in order to render investigation findings for the above allegation. Due to the situation surrounding the coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation findings was conducted telephonically with Clifford Johnson, the facility Assistant Administrator and the purpose of the visit was explained.

The investigation consisted of the following:

On 3/23/21, LPA Brown conducted a 10-day virtual visit and met with Clifford Johnson (Assistant Administrator) and Ella Nayas (Administrator). LPA conducted interviews with Administrators, staff members S1 & S2. LPA requested copies of the following documents: Staff/Residents Rosters, Resident R1's Admission Agreement, Emergency Contact Sheet, Pre-& Current Appraisals, Physician's Reports/Needs & Service, Face sheets, Medication logs, related Incident Reports and Eviction Procedures. On 3/22/21, LPA Brown interviewed Resident #1.
LIC9099-C is on the next page.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

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 4

Control Number 11-AS-20210316154508

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: 04/02/2021

NARRATIVE

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Regarding the allegation: Illegal Eviction

LPA received a complaint on 3/16/21 regarding the above allegation. On 3/16/21 LPA called and spoke to Aharon Striks, the Licensee/Administrator over the telephone regarding the above allegation. Aharon stated R1 being evicted because R1 breaks house rules and doesn’t follow the facility policies. LPA reviewed Community Care Licensing records and there was no record of the eviction being sent to the Regional Office. On 3/16/21, LPA received the eviction notice via email at 4:48 PM. The letter was dated 3/3/21 and indicated they are giving the resident a 30 day notice to find another living location to accommodate her.

On 3/22/21, LPA interviewed Resident R1 regarding the above allegation via telephone. R1 stated she was given an eviction notice on 3/3/31 by the Assistant Administrator. R1 stated everything they are saying is a lie and has not refuse to follow policies. R1 also stated she doesn’t have altercations with staff and hasn’t refused to take medication. She also mentioned that she sees the physician at the facility. On 3/23/21, LPA Brown interviewed Assistant Administrator Clifford Johnson and Administrator Ella, over the telephone. They both stated R1 was given a 30-day notice that she was being evicted for breaking the admission’s agreement. They stated she makes accusation regarding the house keepers stealing her clothes. She also complained about the food. They also stated other residents complained of her screaming and hitting the walls. They stated she refuses to see the doctor and to take her medication. LPA asked them what was the protocol for evictions? They stated the facility protocol is to give residents 3 verbal/written warnings. They will notify all responsible parties and Licensing. LPA interview staff S1 & S2 they stated no residents have given them a hard time but if they do will notify the administrators. They also stated were not aware of any illegal evictions.

LIC9099-C is on the next page.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20210316154508

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: 04/02/2021

NARRATIVE

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On 3/24/21 LPA interviewed Administrator Aharon Striks over the telephone. He stated R1 and her responsible party was given a 30 days eviction notice. He stated R1 is being evicted for breaking house rules. He stated letter was sent to licensing on 3/16/21.

LPA conducted a file review of facility’s Plan of Operation. The admissions agreement indicated a resident displaying a change in health physically/mentally will need a Re-appraisals and a meeting with the resident and appropriate individuals to the change. Upon reviewing R1 file, LPA did not see a meeting conducted with R1or Responsible Party. Facility’s Eviction Policy stated they may provide a 30-day eviction notice to resident and responsible person. They will also need to notify licensing agency within 5 days. Based on interviews and files reviewed the administrator did not adhere to their eviction procedure outline in their Plan of Operation.

Substantiated: Based on LPA's observations, file reviews and interviews with administrators and staff which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22 Division (6) and Chapter (2) are being cited on the attached LIC9099-D.

A telephonic exit interview was conducted with Administrator, and a hard copy of the report and appeals rights was provided via email for records

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20210316154508

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: 04/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 04/12/2021 Section Cited CCR 87208(a)	1 2 3 4 5 6 7	Plan of Operation:(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license ... This requirement was not met as evidence by:	1 2 3 4 5 6 7	Administrator will rescind eviction notice regarding R1 and to ensure eviction procedure is issued to reflect Title 22 and plan of operation. Administrator will send copy by poc due date 4/12/21 to LPA's M. Brown attention.
	8 9 10 11 12 13 14	Based on LPA's observations, interviews with the administrators & R1 and review of the Plan of Operation. They did not adhere to their eviction procedure that was outline in the Plan of Operation. This poses a potential Health and Safety risk to residents in care	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021

LIC9099 (FAS) - (06/04)

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