198603319-4-4-2024-11-AS-JHAD-D45PHS-20240408112024

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 04/04/2024
Date Signed: 04/04/2024 10:28:13 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/06/2021 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20210806163809

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: 66	DATE:	04/04/2024
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	ADMINISTRATOR AHARON STRIKS		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff neglect resulting in resident suffering from dehydration.
Resident suffered falls while in care resulting in injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced subsequent visit to the facility and was greeted by Administrator (A1: Aharon Striks). LPA spoke to A1 prior to entering the facility to conduct a risk assessment. A1 informed LPA that the facility has no COVID cases nor do any of the residents or staff have symptoms. LPA explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.
The investigation consisted of the following:
Licensing Program Analyst (LPA) Ana Soto conducted the unannounced 10-Day visit on 08/09/21 approximately 10:00 a.m. LPA initiated an investigation into the above-mentioned allegations and conducted a face-to-face interview with Asst. Administrator (A2: Clifford Johnson). LPA requested copies of the following documents: Physician’s Report (dated 07/30/2021), Pre-appraisal (dated 05/10/2021), Admissions Agreement (dated 05/10/2021, 07/31/2021), Appraisal/Needs and Services Plan (dated 09/05/2021), Medication Administration Record (July 2021).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

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 3

Control Number 11-AS-20210806163809

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BEVERLY HILLS TERRACE	FACILITY NUMBER: 198603319
	VISIT DATE: 04/04/2024

NARRATIVE

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This complaint investigation was referred to the California Department of Social Services Investigations Bureau (IB) and was assigned to Investigator Olivia Spindola which included a review of Cedar Sinai Medical Center (CSMC), medical records (dated 07/31/2021); interviews conducted of Staff #1, #2, #3, #4; Residents #1, #4, #5, #6; Witness #2. An interview with Witness #1 was attempted, but to no avail at the close of this investigation.

The investigation revealed the following:

Regarding Allegation #1: Resident #1 was hospitalized on 07/31/21 at Cedar Sinai Medical Center (CSMC) and diagnosed with urinary retention, acute renal failure, altered consciousness, toxic metabolic encephalopathy. Resident #1 received a medical procedure on 08/05/21 at CSMC based on clinical history of diabetes militia II (DM2). Resident #1 was discharged from CSMC hospital on 08/10/21 with the diagnosis of inpatient rehab, DM2, dyslipidemia, hypertension, morbid obesity, bipolar disorder type, thrombocytopenia, and macrocytosis. Facility staff have the capability of meeting the resident’s medical needs; and Resident #1 can care for themself. A review of Resident #1’s Physician’s Report documented that the resident is ambulatory and could care for themself and does not require assistance. Interviews conducted of facility staff corroborated that although Resident #1 appears to not make the best decisions regarding their diabetic diet, facility staff ensures to monitor Resident #1’s water intake and medical care needs. Resident #1 admitted that the facility takes good care of them and is responsive to their needs. The food that is provided at the facility meets R1’s diabetic diet. Resident #1 admitted that they like to drink sodas and eat hamburgers when they are out in the community. Resident #1 stated that they get their sugar levels checked every morning and the resident can care for their own needs without assistance.

Based on the evidence gathered and interviews conducted, and records reviewed, 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 of NEGLECT/LACK OF CARE AND SUPERVISION: Staff neglect resulting in resident suffering from dehydration is found to be UNSUBSTANTIATED.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210806163809

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BEVERLY HILLS TERRACE	FACILITY NUMBER: 198603319
	VISIT DATE: 04/04/2024

NARRATIVE

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03/13/24

Regarding Allegation #2: Resident #1 has a history of recurrent falls attributed to psychosis and morbid obesity. Resident #1’s platelets were between 120,000 to 160,000 for the last six (6) months as an outpatient. Possible thrombocytopenia secondary to Depakote; hyperkalemia secondary to CKD mild; metabolic acidosis, gait disorder. Iron panel suggestive of anemia of chronic disease. Resident #1 admitted that they recall going out to the community to purchase sodas at a store when R1 tripped and fell and hit their face and was hospitalized for the fall. Resident #1 stated that the facility takes good care of them and is responsive to their needs. A review of the Incident Report (dated 8/6/2021) documented that the resident sustained a fall outside the community and was transported to Cedar Sinai Medical Center (CSMC) for observation.

Based on the evidence gathered and interviews conducted, and records reviewed, 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 of NEGLECT/LACK OF CARE AND SUPERVISION: Resident suffered falls while in care resulting in injuries is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to Administrator (A1: Aharon Striks).

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

LIC9099 (FAS) - (06/04)

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