198603319-4-14-2023-11-AS-MVAO-CSBTEB-20230530143935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 05/26/2022
Date Signed: 04/14/2023 02:16:52 PM

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
01/14/2022 and conducted by Evaluator Martessa Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220114151554

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:	05/26/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Bella Neygas		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident has unidentified bites on their body whle in care

INVESTIGATION FINDINGS:

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This report serves as an amendment to the complaint report created on 05/26/2022. This report supersedes the complaint investigation findings reflected on the complaint report created on 05/26/2022, However this report was created on 4/14/23.

On 1/19/22 Licensing Program Analyst (LPA) Martessa Brown conducted a 10 day visit regarding the e above listed allegations. LPA met with Cesilia Torres, the facility Assistant Administrator and the purpose of the visit was explained. LPA obtained the following documents: LIC 500 and Staff Roster, Residents #1-2 admission agreements, most recent physician reports/appraisals, needs & service, emergency contacts, medication list and records. LPA requested incident reports, pest control invoices for the past 6 months due by 1/25/22.
On 5/17/22 and 5/26/22 , Licensing Program Analyst (LPA) Martessa Brown conducted a subsequent complaint visit in order to render investigation findings. During today’s visit LPA met with Bella Naygas the Administrator and the purpose of the visit was explained. LPA toured the medication room and reviewed R1-2 medications and logs. LPA conducted interviews with the administrator, residents #R2-R7, Staff #1-7.
The investigation revealed the following:
LIC 9099-C is on the next page.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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-20220114151554

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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Regarding the allegation: Resident has unidentified bites on their body while in care

On 5/17/22 LPA interviewed Bells Naygas regarding the above allegation and she stated was not aware of any residents having scabies or bedbugs and pest control comes out to the facility once a month. LPA interviewed staff #1-7, staff stated facility had a problem bedbug and did not have scabies. LPA did not interview R1 due to not being at the facility. LPA interview residents (R2-R7), 2 out of 7 residents stated they had bedbugs in their bedrooms. LPA interviewed Witness (W1) and stated resident R1 was diagnosed with scabies when admitted to the hospital. LPA reviewed hospital records and it was indicated R1 had scabies. During the investigation the administrator did not identify that R1 had scabies and needed to have R1 seen by the doctor. Based on Interviews and documents gathered during this investigation, LPA found sufficient evidence to support that the above-mentioned allegation is substantiated.

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.

Exit interview was conducted and a copy of the report and appeal rights was given to Cesilia Torres.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220114151554

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: 05/26/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/27/2022 Section Cited CCR 87465(h)(C)(5)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored:(C)Because of potential dangers related to the medication itself, or due to physical arrangements in the facility...(5) Each resident's medication shall be stored ..This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator will review the regulation and have an in-service training with all staff and have all staff sign training . Administrator will provide proof to LPA via email by 5/27/22.
	8 9 10 11 12 13 14	Based on observation and interviews conducted, LPA observed medication room and the residents medications were already prepared in a container 2 days in advance by administrator. This is an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14
Type B 06/01/2022 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator will review the regulation to ensure residents are to accorded safe and healthy conditions. Administrator will send a statement and come up with a plan on how she will ensure residents are provided healthful and comfortable environment. Administrator will provide proof to LPA by 6/1/22.
	8 9 10 11 12 13 14	Based on observation, interviews conducted and documents. LPA conducted interviews with residents, staff and social worker and it was confirmed facility has scabies and bed bugs. This is a potential health and safety risk to clients 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: Eva M Alvarez	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

LIC9099 (FAS) - (06/04)

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