198603319-7-23-2024-11-AS-JHAD-D7HMWB-20240725095805

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 07/20/2024
Date Signed: 07/23/2024 03:52:02 PM

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
07/05/2024 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240705143922

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: 67	DATE:	07/20/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ella Naygas		TIME COMPLETED:	10:47 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not prevent resident from being abused by another resident.
Resident was chemically restrained while in care.
Staff did not meet resident’s medical needs.
Staff did not provide a safe and comfortable environment.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 07/20/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced visit at this facility. LPA was greeted by the Administrato Ella Naygas. LPA explained the purpose of this visit was to deliver findings for the allegations mentioned above.

The investigation consisted of the following: A copy of the facility's roster for residents and staff, service records for resident #1-#2 (R1-R2) Physician Report LIC 602A (dated: 03/12/24 and 01/17/24), Appraisal/Needs and Services Plan (dated: 03/08/24 and 02/08/24), and Unusual Incident Report LIC 624 (dated: 05/30/24 and 05/31/24), Physician’s Orders Medications List (dated: 07/07/24 - 08/06/24), and other records associated with this complaint. Interviews with residents #1-10 (R1-R10) and administrator #1 (A1) and staff #1-#2 (S1-S2). A plant inspection of the facility of rooms #218 and #229 and common areas.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2024

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 5

Control Number 11-AS-20240705143922

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: 07/20/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff did not prevent resident from being abused by another resident.

In the complaint, it was alleged that resident #1 (R1) was abused by another resident and that no action was taken by staff to prevent it. The complainant did not provide further information about this matter.

Investigation revealed resident #1 (R1) came from Sunray Healthcare Center. According to resident #1 (R1’s) Identification and Emergency Information LIC 601 (dated: 04/11/23), (R1) was admitted to Beverly Hills Terrance on 04/10/23. (R1’s) Physicians Report LIC 603A (dated: 03/12/23) is diagnosed with mental illness.

On 07/11/24, between 10:15 am - 01:00 pm, the Department interviewed (9) out of (10) residents #1- #R3-R10 (R1) (R3-R10) who denied having experienced physical assault while in care at this facility. (R1) (R3-R10) claimed not to have witnessed any physical altercations or assaults between residents. (R1) (R3-R10) commended the facility staff and mentioned they were responsive to their care and supervision. (R1) professed that (R2) had never engaged in physical contact or verbal interaction with (R1). (R2) claimed that (R1) has intimidated (R2) with verbal exchanges but no physical abuse.

On 07/11/24, between 09:30 am – 01:30 pm, the Department interviewed assistant administrator #1 (A1) and staff #1 (S1) claimed this allegation was untrue. (A1-S1) stated that (R1) spends limited time inside the facility and spends most of the time out in the community to have any interactions with (R2). (A1) explained that (R1) and (R2) were friends and former roommates who had fallen out of friendship which led to some arguments between each other. There have been no physical or verbal abuse only disagreements with each other. (A1-S1) reported they have been separated from non-adjacent private rooms. (A1-S1) claimed when they are seen engaging with one another a staff will intervene to distance both residents from one another. (R1) and (R2) were both diagnosed with mental illness and behaved negatively when medications were not taken.

On 07/15/24, between 10:17 am – 10:45 am, the Department interviewed (1) out of (1) staff #2 who verified (S2) had intervened in an incident between (R1) and (R2) on 05/31/24. (S3) recalled intervening in a heated situation between (R1) and (R2) where (R1) was the integrator. (R1) was escorted to (R1’s) room while (S2) was dispatched for additional staff assistance. (S3) claimed that there was no physical violence nor did the residents sustain any injuries. (Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20240705143922

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: 07/20/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

As a result of the Department reviewing (R1’s-R2’s) Physician Report LIC 602A (dated: 03/12/24 and 01/17/24), Appraisal/Needs and Services Plan (dated: 03/08/24 and 02/08/24), and Unusual Incident Report LIC 624 (dated: 05/30/24 and 05/31/24) verified (R1 and R2)) both been evaluated with a history of mental illness. A review of (R1’s – R2’s) Physician’s Orders Medications List (dated: 07/07/24 - 08/06/24), revealed (R1) is on (11) routine medications and (R2) is on (8) prescribed medications. Twelve (12) out of nineteen (19) prescribed medications have side effects on mental health according to the National Institute of Health (ref: NIH).. Based on the information gathered, there is no sufficient evidence to corroborate the allegation mentioned above.

Allegation #2: Resident was chemically restrained while in care.
It is alleged resident #1 (R1) was chemically restrained while in care at this facility. The complainant reported (R1) is chemically dosed with an unknown grainy toxin. The complainant did not provide further details on this matter.

On 07/02/24, between 10:15 am - 01:00 pm, the Department interviewed (10) out of (10) residents #1-#10 (R1-R10) whose medication management needs have been met nor have medications not been prescribed by their physician been administered. (R1-R10) reported not having experienced any side effects from medications. (R1) declined to have issues or concerns with medications administered by the facility. (R1) denied having any side effects from the medications.

On 07/11/24, between 09:30 am - 01:30 pm, the Department interviewed (2) out of (2) assistant administrator #1 (A1), and staff #1 (S1) claimed this allegation was false. (A1) stated no recent modifications on (R1’s) medications. (A1-S1) reported that (R1) occasionally refused to take medications. (A1-S1) said the facility assisted with self-administration and did not force residents to take medication, hide medication without their knowledge, or otherwise violate their right to refuse.

A review of (R1’s) Medication Administration Record (dated: 07/07/24 - 08/06/24) revealed (R1) is on (11) routine medications and (R2) is on(8) prescribed medications.. Based on the gathered information, there is no evidence to support the allegation mentioned above.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20240705143922

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: 07/20/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation #3: Staff did not meet resident’s medical needs.
The details of the complaint alleged the facility did not meet resident #1 (R1) medical needs. The complainant did not provide further details on this matter.

On 07/11/24, between 10:15 am - 01:00 pm, the Department interviewed (10) out of (10) residents #1-#10 (R1-R10) and confirmed the facility is capable of meeting resident’s medical needs. (R1) rejected having issues or concerns with medical necessities. (R2-R10) indicated the facility has in-house medical professionals who come to the facility to perform medical services for residents and are satisfied with the services provided.

On 07/11/24, between 09:30 am – 01:30 pm, the Department interviewed assistant administrator #1 (A1) and staff #1 (S1) who claimed this allegation was false. (A1-S1) reported all residents must have medical care. (A1) indicated some residents have private primary physicians, and some are seen by in-house physicians. (A1-S1) reported that (R1) often is non-cooperative and will not want to be seen by the in-house medical physician. (A1) stated that (R1) is entitled to refuse medical assistance and medical services are not being forced upon (R1).

A review of (R1’s) Identification and Emergency Information LIC 601 (dated: 04/11/23) and Physicians Report LIC 602A (dated: 03/12/23) verified that (R1) is under medical care and supervision provided by the in-house physician. Based on the gathered information, there is no evidence to corroborate the allegation mentioned above.

Allegation #4: Staff did not provide a safe and comfortable environment.

It is alleged the facility did not provide a safe and comfortable environment for resident #1 (R1). The complainant did not offer additional information on this matter.

On 07/11/24, between 10:15 am - 01:00 pm, the Department interviewed (10) out of (10) residents #1-#10 (R1-R10) and verified the facility maintained a safe and comfortable environment for residents. (R1) denied having any concerns or issues and felt the facility provided a safe setting and comfortable place.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20240705143922

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: 07/20/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

On 07/11/24, between 09:30 - to 01:30 pm, the Department interviewed (2) out of (2) assistant administrator #1 (A1) and staff #1 (S1) who confirmed that the facility does provide a safe and comfortable environment for resident in care. (A1-S1) claimed that there is no type of abuse at this facility and had no concerns. (A1) indicated only recent incidents were between (R1 and R2) with no physical assault and only verbal disagreements with one another. (A1) reported there is 24/7 care and supervision are provided by staff. According to (A1), the facility is equipped with surveillance cameras used to protect residents, staff, and visitors. It is added protection to deter away any activities of theft, vandalism break-ins, or any unwarranted activities.

On 07/11/24, between 01:30 pm – 01:59 pm, the Department inspected (R1’s) room #218 and (R2’s) room #229 including the common areas and observed surveillance cameras on the premises. Based on the gathered information, there is no evidence to corroborate the allegation mentioned above.

Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegations mentioned in this complaint. 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 allegations are Unsubstantiated.

An exit interview is conducted with Ella Naygas, and a copy of the report is provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5