198603319-9-11-2024-11-AS-JHAD-D93RST-20240913131715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 09/11/2024
Date Signed: 09/11/2024 10:30:19 AM

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
09/08/2022 and conducted by Evaluator Sparkle Day

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: 67	DATE:	09/11/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Cecilia Torres		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident had bedbugs on his person due to staff neglect
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) Sparkle Day conducted a visit to the facility to to deliver complaint investigation findings. LPA met with Assist Administrator, Cecilia Torres and the purpose of the visit was explained.
On 09/14/2022 Licensing Program Analyst (LPA) Antonia Alvizar initiated this complaint investigation for the allegations listed above with Administrator Ella Naygas and Assist Administrator Cecilia Torres. During the initial visit LPA Alvizar requested resident roster, staff roster, physical plan and other service, such as medical records, pest control services and caregiver bathing documents on 09/14/2022. LPA Alvizar interviewed R(#1-#7) and S(#1- #5). A plant inspection of the facility was conducted

Allegation #1: Resident had bedbugs on his person due to staff neglect

It is alleged that R#1 had bedbugs on his person. During the 9/14/22 interviews, 0 out of 7 residents agreed with the allegation. 0 out of 5 staff agreed with the allegation. LPA Alvizar did not observe any bedbugs at time of visit. LPA Day reviewed records of pest control services which are conducted 2 times a month by Environworx Pest Control and more if needed. Based on interviews conducted, observation and pest control records services there is no sufficient evidence to corroborate the above allegation.LPA finds

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

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-20220908111405

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: 09/11/2024

NARRATIVE

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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 #2: Resident sustained a stage 1 pressure injury while in care due to staff neglect

It is alleged that Resident #1 (R#1) sustained a pressure injury while in care. During the 9/14/2022 interviews with LPA Alvizar 0 of 7 residents disagreed with the above allegation and did not know of any pressure injury. 0 of 5 staff disagreed with the allegation and did not know of any pressure injury. LPA Day reviewed last physician report dated 8/20/2022 and hospital discharge dated 9/3/2022 . LPA Day did not observe any diagnosis of pressure injury. Based on interviews conducted and medical records reviewed there is no sufficient evidence to corroborate the above allegation. Therefore 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 #3: Resident had feces on his feet due to staff not meeting residents hygiene needs

It is alleged that R#1 had feces on his feet due to staff not meeting residents hygiene needs.. During the 9/14/2022 interviews of residents and staff with LPA Alvizar . 0 out of 7 residents disagreed with the allegation.
0 out of 5 staff disagreed with the allegation. Staff have a schedule for daily showers for residents and every 2 hours the briefs of incontinent resident are changed but if it is an emergency they change right away. Based on interviews conducted there is no sufficient evidence to corroborate the above allegation. Therefore 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 Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC9099 (FAS) - (06/04)

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