198603319-8-1-2024-11-AS-RORN-D98KWR-20240918081619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 07/31/2024
Date Signed: 08/01/2024 08:03:23 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, 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
07/24/2024 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20240724135550

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:	07/31/2024
		UNANNOUNCED	TIME BEGAN:	09:57 AM
MET WITH:	Cesilia Torres		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident's bathroom is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, 07/31/2024. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Assistant Administrator Cesilia Torres. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: Interviews were conducted with staff members 1-3 (S1-S3) and residents 1-7 (R1-R7). LPA Bunker asked questions pertinent to the nature of the complaint. Allegation #1: Resident's bathroom is in disrepair: S1-S3 stated that the bathroom sinks in each resident's room are functioning properly, and none of the residents complained about their sink being backed up for five days. S1-S3 stated that the facility did not have a plumbing problem and did not have a plumber scheduled to come to the facility on Tuesday. R1-R7 stated that their bathroom sinks are working fine and reported no issues with their sinks. LPA Bunker requested copies of the Personnel Report and Resident Roster.See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

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-20240724135550

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS TERRACE	FACILITY NUMBER: 198603319
	VISIT DATE: 07/31/2024

NARRATIVE

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Continued LIC9099-C page 2

Investigation revealed the following: Interviews with staff members 1-3 (S1-S3) and residents 1-7 (R1-R7) all stated that residents' bathroom sinks are in working and operable condition. S1 Cesilia Torres, S2 Norman Jones, and LPA Bunker toured seven resident's bedrooms and bathrooms in rooms 108, 111, 114, 215, 218, 219, and 228. During the tour, S1 and S2 turned on the sinks, flushed the toilets, and tested the bathtubs and showers. All fixtures were functioning properly, and the water was draining without any issues. S1-S3 and R1-R7 stated none of the sinks had been backed up for five days. S1-S3 also stated that the facility had not scheduled a plumber appointment for Tuesday. S1-S3 and R1-R7 stated if the facility experienced a plumbing problem or if a resident's bathroom sink was backed up, it would be addressed and resolved immediately. S1-S3 stated if there were an issue with the facility plumbing they would have reported the incident to all the appropriate agencies in a timely manner. During today's visit, no plumbing problems were observed, and the bathrooms were not in disrepair. S1-S3 and R1-R7 all denied the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to Assistant Administrator Cesilia Torres.

There were no deficiencies cited.

Exit interview conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

LIC9099 (FAS) - (06/04)

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