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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 09/07/2024
Date Signed: 09/07/2024 03:28:10 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
08/28/2024 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240828155936
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: 64DATE:
09/07/2024
UNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Cesilia TorresTIME COMPLETED:
09:59 AM
ALLEGATION(S):
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Staff withheld residents’ personal funds.
Staff did not provide residents with adequate personal care supplies.
Staff did not seek timely medical attention for resident.
Staff inappropriately restrained resident.
INVESTIGATION FINDINGS:
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On 09/07/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit at this facility. LPA was greeted by Assistant AdministratorAdministrator Cesilia Torres. LPA explained the purpose of this visit was to deliver findings for the allegations mentioned above.

The investigation consisted of the following: An initial investigation visit on 09/04/24. A review of the Register of Resident Roster, Personnel Report LIC 500, Service records for resident #1 (R1-R4) including Physicians Report LIC 602A, Identification and Emergency Information LIC 601, Admission Agreement, Preplacement Appraisal Information LIC 603, Appraisal Needs/Services Plan LIC 625 and other documents pertinent to the allegations associated with this complaint. Interviews were conducted with Administrators #1-#2 (A1-A2), and residents #1-#9 (R1-R9). A tour of the facilty was conducted.

(Evaluation Report continues LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/07/2024
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 4
Control Number 11-AS-20240828155936
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: 09/07/2024
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff withheld residents’ personal funds.
The details of the complaint alleged residents’ personal funds are being with by staff. Information reported that staff withheld (P & I) funds and SSI money for residents #2-#4 (R2-R4) since they first arrived at the facility.

On 09/04/24, between 10: 48 am - 02:00 pm, the Department interviewed (9) out of (10) residents #1- #R2-R10 (R2-R10) who denied having any issues with their funds managed by the facility. (R3-R4) mentioned that their main income is Supplemental Security Income (SSI) and that the facility is the payee. The basic monthly fee (rent) is deducted each month, and the rest is their Personal and Incidental (P&I). (R2 and R4) verified that they do not have an issue with the facility handling their funds, and they have had no discrepancies with their (P&I) funds. (R2) handles (R2’s) funds and is the payee to (SSI) and not the facility.
On 09/04/24, between 09:38 am – 10:45 am, the Department interviewed administrators #1-#2 (A1-A2) reported having no questions or disagreements with the resident’s funds. (A1) stated that not all residents’ funds are being handled by the facility as some of the residents handle their personal funds and are the payee to their (SSI). (A1) verified that (R2) handled (R2’s) funds while (R3-R4) had the facility to their (SSI) as the payee and received (P&I) monthly.

As a result of the Department reviewing (R2-R4’s) Admissions Agreement and Contract (dated: 08/20/20 - 07/20/24), and (R3-R4’s) Record of Client’s/Resident’s Safeguarded Cash Resources (dated: 01-05-24 through 09-05-25) along with Physicians Report LIC 602A where it revealed it is accurate and did not disclose any discrepancies and that (R3-R4) is not able to manage their own cash resources Based on the gathered information, there is no evidence to support the allegation mentioned above.

Allegation #2: Staff did not provide residents with adequate personal care supplies.
In the complaint, it was alleged that the resident was not provided with adequate personal care supplies by staff. It is reported that residents #2-#4 (R2-R4) did not have enough money to purchase their hygiene products and that the administrator did not provide personal care supplies to them.
(Evaluation Report continues LIC 9099-C)
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20240828155936
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: 09/07/2024
NARRATIVE
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On 09/04/24, between 10: 48 am - 02:00 pm, the Department interviewed (9) out of (10) residents #1- #R2-R10 (R2-R10) stated that had no issues obtaining personal care supplies from the facility. (R2-R4) had no concerns or issues with purchasing their personal care supplies as it is a preference. (R2-R4) is aware if they ever are out of personal care supplies, they can attain these from the facility.

On 09/04/24, between 09:38 am – 10:45 am, the Department interviewed administrators #1-#2 (A1-A2) reported having no issues providing personal care supplies to their residents. (A1) stated we have an inventory supply of basic hygiene items for the resident’s disposal. (A1) stated residents must ask and no one is refused this service. (A1-A2) stated although some residents are aware that we do provide this service, will favor purchasing their personal care supplies at the preference. According to (A1), although the facility is only responsible for toilet paper and soap under their Admissions Agreement and Contract, the facility extends to provide residents with other hygiene supplies at no cost.

The Department reviewed (R2-R4’s) Admission Agreement and Contract (dated: xx-xx-xx) which indicated that “basic hygiene items such as soap and toilet paper are provided”. “Other personal articles, i.e. toothpaste, mouthwash, shampoo, Kleenex, etc. are the responsibility of the resident or resident’s representative”. Based on the gathered information, there is no evidence to corroborate the allegation mentioned above.

Allegation #3: Staff did not seek timely medical attention for resident.
Allegation #4: Staff inappropriately restrained resident.
It is alleged resident #4 (R4) was neglected medical attention in a timely manner and improperly restrained by staff. Information reported on 08/27/24, (R4) fell out of a wheelchair, and staff did not want to assist or dispatch an ambulance. Furthermore, (R4) was tied to the wheelchair with a long gown.

On 09/04/24, between 10: 48 am - 02:00 pm, the Department interviewed (9) out of (10) residents #1- #R2-R10 (R2-R10) and claimed they were unable to corroborate these allegations that had not witnessed any resident not getting the medical attention or restrained. (R4) denied having fallen or had any accident requiring restraint to a wheelchair on 08/27/24. (R5) co-resident of (R4) verified that no such incident had occurred with (R4). (R5) never observed (R4) being restrained by any device.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20240828155936
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: 09/07/2024
NARRATIVE
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On 09/04/24, between 09:38 am – 10:45 am, the Department interviewed administrators #1-#2 (A1-A2) and reported these allegations were false. (A2) stated to have been present on 08/27/24 and claimed that (R4) did not have a fall or had an accident. (R4) was lying on the floor of (R4’s) preference when (R4) was assisted by two caregivers to a wheelchair. (R4) did not exhibit pain or injuries, so there was no need to seek medical attention. (A2) denied (R4) ever being restrained of any devices.

On 09/04/24, between 11:15 am – 11:45 am, the Department interviewed staff #1-#2 (S1-S2) and verified to have been present on 08/27/24 with (R4) and disputed these accusations. (S1-S2) confirmed that (R4) did not fall or have an accident. (S1-S2) assisted (R4) to a wheelchair while (R4) lay on the floor of (R4) own accord. (R4) was never restrained by the use of ties or devices to a wheelchair.

As a result of the Department reviewing (R4’s) Admissions Agreement and Contract (dated: 08/28/20), Physicians Report LIC 602A (dated: 02/06/24), Appraisal/Needs and Service Plan LIC 625 (date: 12/20/23) revealed that (R4) has the capacity for self-care and is not considered a fall risk. A review of Facility Progress Notes (dated: 08/27/24) verified the incident with (R4) was no fall/accident and no restraint was observed on 08/27/24. Based on the gathered information, there is no evidence to support the allegation mentioned above.



An interview with resident #1 (R1) was not available. (R1) refused to participate in an interview.

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 Cesilia Torres, and a copy of the report is provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/07/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4