198603319-8-21-2024-11-AS-UCOL-D8ZUQE-20240911154700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 08/21/2024
Date Signed: 08/21/2024 01:21:43 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
08/15/2024 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20240815122554

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: 68	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	ADMINISTRATOR ELLA NAYGAS		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not ensure the residents are properly fed
Staff do not ensure the water source is safe for the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Beverly Hills Terrace Facility on 08/21/2024 and was greeted by Administrator Ella Naygas (A1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following: LPA Calderon interviewed Administrator (A1), staff (S1-S2), residents (R1-R7). LPA Calderon requested and reviewed copies of the following: Physician Report (dated 03/12/2023), Needs and Services Plan (dated 03/08/2024), incident report (dated 05/31/2024), admission agreement (dated 04/11/2023), 30-day eviction notices (dated 11/15/2023, 07/26/2024) for R1 and weekly meal plan.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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-20240815122554

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: 08/21/2024

NARRATIVE

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Regarding Allegation #1: Staff do not ensure the residents are properly fed.

It is being alleged that staff did not feed residents and residents went hungry. LPA Calderon toured the facility with A1. During tour of the facility LPA noted the dining room was full of residents having lunch. LPA noted hot dogs and beans with bread was served. The food appeared to smell and look good to eat. LPA Calderon asked the 20 residents how the food was, and all replied the food was “great”. LPA noted a weekly meal plan posted outside the dining room area. Reviewed the weekly meal plan for the facility. The meal plan had 3 meals served daily and appeared to be balanced for resident’s needs. 3 out of 3 staff indicate that 3 meals are served daily, and no resident goes hungry for lack of food. R1 left the facility and could not be interviewed. 6 out of 7 residents indicate that 3 meals are served daily, and no resident goes hungry. 6 out of 7 residents indicate that a weekly meal plan is posted near the dining room area.

Regarding Allegation #2: Staff do not ensure the water source is safe for the residents.

It is being alleged that the facility water supply is not safe for residents to drink. LPA toured the facility with A1. LPA opened the bathroom faucet and the water appeared to be clear and had no smell. LPA observed the kitchen used filtered water for all meals. LPA Calderon entered the dining room for lunch and noted 20 residents having lunch. LPA Calderon asked the 20 residents how the water tasted, and all replied there were no issues with the water. 3 out of 3 staff indicate no issues with the facility water and no resident has made a complaint about the smell or taste of the water. R1 left the facility and could not be interviewed. 6 out of 7 residents indicate that they drink and shower with the facility water and have no concerns or issues with the facility water supply.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff do not ensure the residents are properly fed”, “staff do not ensure the water source is safe for the residents” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Ella Naygas A1.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

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