198603319-1-30-2023-11-AS-JHAD-D93RSU-20240913131716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 01/30/2023
Date Signed: 01/30/2023 03:57:00 PM

Unsubstantiated

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
09/08/2022 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220908111405

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: 69	DATE:	01/30/2023
		UNANNOUNCED	TIME BEGAN:	01:33 PM
MET WITH:	Assist Administrator, Cecilia Torres		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Resident sustained a stage 1 pressure injury while in care due to staff neglect
Resident had feces on his feet due to staff not meeting residents hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Antonia Alvizar conducted a visit at this facility to deliver complaint investigation findings. LPA called facility via-phone no answer LPA conducted COVID -19 risk assessment at facility front door, facility has no COVID-19. LPA met with Assist Administrator, Cecilia Torres and the purpose of the visit was explained.

The investigation consisted of the following: On 09/14/2022 Licensing Program Analyst (LPA) Antonia Alvizar initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Administrator Ella Naygas and Assist Administrator Cecilia Torres.

LPA requested resident roster, staff roster, physical plan and other service documents on 09/14/2022. LPA Alvizar interviewed R(#1-#7) and S(#1- #5). A plant inspection of the facility was conducted.

Continue on LIC 9909-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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-20220908111405

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: 01/30/2023

NARRATIVE

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Regarding the allegation: “Resident sustained a stage 1 pressure injury while in care due to staff neglect” On 09/14/2022 during interviews conducted it revealed the following, 5 out of 7 residents did not know about the allegation, resident R#1 stated, “I don’t know” . 2 out of 7 residents disagree with the allegation, resident R#6 stated, "I could not tell you my roommate has a sickness and staff check on him all the time. I never saw any staff neglect". 0 out of 7 residents agreed the with allegation. 2 out of 5 staff did not know about the allegation, Staff S#3 stated, “I don’t know I just do cleaning”. 3 out of 5 staff disagree with the allegation, staff S#2 stated, “I have not seen a resident with a stage 1 pressure injury and no staff has reported to me about a pressure injury”. 0 out of 5 staff agree with the allegation. Based on interviews the above allegation is Unsubstantiated.

Regarding the allegation: “Resident had feces on his feet due to staff not meeting residents hygiene needs” On 09/14/2022 during interviews conducted it revealed the following, 3 out of 7 residents did not know about the allegation, resident R#3 stated, “I don’t know and I don’t have any knowledge of that”. 4 out of 7 residents disagree with the allegation, resident R#5 stated, "No, I never seen that most of them wear diapers” 0 out of 7 residents agreed the with allegation.
5 out of 5 staff disagree with the allegation, staff S#1 stated, “Not true, I have a schedule for shower and every 2 hours we change briefs but if it is an emergency we change right away”. 0 out of 5 staff agree with the allegation. Based on interviews the above allegation is Unsubstantiated.

Based on interviews the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.”

Exit interview conducted and a copy of report was provided Assistant Administrator, Cecilia Torres.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC9099 (FAS) - (06/04)

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