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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 07/09/2024
Date Signed: 07/09/2024 02:19:43 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
12/21/2022 and conducted by Evaluator Sparkle Day
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221221113415
FACILITY NAME:BEVERLY HILLS TERRACEFACILITY NUMBER:
198603319
ADMINISTRATOR:STRIKS, AHARONFACILITY TYPE:
740
ADDRESS:1470 S ROBERTSON BLVDTELEPHONE:
(310) 273-3668
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:110CENSUS: 66DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Cecilia TorresTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff did not meet resident's hygiene needs.
Facility staff did not note a change in resident's condition.
Facility staff did not seek resident timely medical attention.
Facility staff did not ensure that resident was free from bed bugs.
Facility staff neglect resulted in resident sustaining a pressure injury.
INVESTIGATION FINDINGS:
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On 7/9/2024, Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced subsequent complaint visit to deliver complaint investigation findings. LPA Day met with Cecilia Torres,Asst Administrator and explained the purpose of today’s visit.

The investigation consisted of the following: On 12/28/2022, LPA Lourdes Montoya toured the facility with the Administrator. LPA requested resident roster, staff roster, pest control invoices, and Resident #1's service records (Admission Agreement, Appraisal, Physician's Report, Doctor's/Hospital records, Home Health nurses notes and other pertinent records. LPA interviewed three staff (S1-S3). On 12/29/2022, LPA interviewed eight residents (R2-R9). R1 is in the hospital and not available for interview during LPA's visit.
The investigation revealed the following:

Allegation: Facility staff did not meet resident's hygiene needs.
It is alleged that facility staff did not meet resident's hygiene needs. On 12/28/2022 between 11:55 am
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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 2
Control Number 11-AS-20221221113415
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: 07/09/2024
NARRATIVE
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and 1:15 pm, LPA Montoya conducted interviews with three out of twenty-three staff (S1-S3). On 12/29/2022 from 9:40 am – 11:55 am, LPA interviewed eight out of seventy-one residents (R2-R9). R1 was in the hospital and not available for interview. Based on interviews conducted, eight out of eight residents (R2-R9) and three out of three staff (S1-S3) denied that facility staff did not meet resident's hygiene needs. Three staff (S1-S3) revealed staff are consistent with their hygiene assistance to R1 but sometimes R1 refuses the assistance. Based on records review, physician’s report shows R1 needs assistance with bathing, but is capable of dressing ,toileting and grooming himself . LPA did not observe R1 in the facility. LPA did not observe any residents with bad hygiene. Based on information gathered, LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated

Allegation: Facility staff did not note a change in resident's condition.


It is alleged that facility staff did not note a change in resident's condition. On On 12/28/2022 between 11:55 am and 1:15 pm, LPA Montoya conducted interviews with three out of twenty-three staff (S1-S3). On 12/29/2022 from 9:40 am – 11:55 am, LPA interviewed eight out of seventy-one residents (R2-R9). R1 was in the hospital and not available for interview. Based on interviews conducted, eight out of eight residents (R2-R9) and three out of three staff (S1-S3) denied that facility staff did not note a change in resident's condition. Based on records review, R1 had a change of medical condition determined by a medical practitioner on 10/7/2022 and 12/20/2022 which was noted and R1 was sent to hospital which was noted. LPA did not observe any complaints during the visit that staff failed to note a change in resident’s condition. Based on information gathered,LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated

Allegation: Facility staff did not seek resident timely medical attention.

It is alleged that facility staff did not seek resident timely medical attention. On 12/28/2022 between 11:55 am and 1:15 pm, LPA Montoya conducted interviews with three out of twenty-three staff (S1-S3). On 12/29/2022 from 9:40 am – 11:55 am, LPA interviewed eight out of seventy-one residents (R2-R9). R1 was in the hospital and not available for interview. Based on interviews conducted, eight out of eight residents (R2-R9) and three out of three staff (S1-S3) denied that facility staff did not seek resident timely medical attention. Three staff (S1-S3) stated on 12/20/2022 around 12:40 AM, staff observed that R1 was not feeling well and looked pale. The administrator immediately called 911. Based on records review, paramedic came at 12:46 am which is noted. Based on information gathered, LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated

Allegation: Facility staff did not ensure that resident was free from bed bugs.

It is alleged that facility staff did not ensure that resident was free from bed bugs. On 12/28/2022 between 11:55 am and 1:15 pm, LPA Montoya conducted interviews with three out of twenty-three staff (S1-S3). On 12/29/2022 from 9:40 am – 11:55 am, LPA interviewed eight out of seventy-one residents (R2-R9). R1 was in the hospital and not available for interview. Based on interviews conducted, three out of eight residents and three out of three staff revealed there were bed bugs in the past. A pest control company provides an ongoing pest control treatment to the facility. Six out of eight residents denied that facility staff did not ensure that resident was free from bed bugs. Based on records review, a record of pest control services are conducted 2 times a month by Environworx Pest Control and more if needed LPA did not observe bed bugs in the facility. Based on information gathered, LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated

Allegation: Facility staff neglect resulted in resident sustaining a pressure injury.

It is alleged that facility staff neglect resulted in resident sustaining a stage 1 pressure injury. On 12/28/2022 between 11:55 am and 1:15 pm, LPA Montoya conducted interviews with three out of twenty-three staff (S1-S3). On 12/29/2022 from 9:40 am – 11:55 am, LPA interviewed eight out of seventy-one residents (R2-R9). R1 was in the hospital and not available for interview. Based on interviews conducted, eight out of eight residents (R2-R9) and three out of three staff (S1-S3) denied that facility staff neglect resulted in resident sustaining a pressure injury. Based on records review, R1 received Home health care from 10/15/22 to 12/13/2022 after which he was able to return to his previous level of functioning . LPA did not observe R1 in the facility. Based on information gathered, LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2