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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603319
Report Date: 09/25/2024
Date Signed: 09/25/2024 03:10:47 PM


Document Has Been Signed on 09/25/2024 03:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 TERRACEFACILITY NUMBER:
198603319
ADMINISTRATOR:STRIKS, AHARONFACILITY TYPE:
740
ADDRESS:1470 S ROBERTSON BLVDTELEPHONE:
(310) 273-3668
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:110CENSUS: 70DATE:
09/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Cecilia Torres, Asst AdministratorTIME COMPLETED:
03:30 PM
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,Licensing Program Analyst (LPA) Sparkle Day conducted a Case Management site visit to the facility to ascertain information pertaining to the Licensee-initiated Incident Report which occurred on 09/06/24. LPA met with Assistant Administrator Cecilia Torres who assisted with the visit.

On 9/7/2024 R#1 informed Assistant Administrator Cecilia Torres that on 9/6/24 sometime after dinner her room mate R#2 allowed 4 guys into her room and she was raped by one of them. R#1 informed Asst Administrator that two of the guys that came in the room were R#3 and R#4 and the other guys were unknown. Asst Administrator called the Police immediately. When the police arrived R#1 was taken to the UCLA Medical Center Santa Monica and discharged the same day.

During todays visit LPA interviewed the following residents: R#1, informed LPA that that never happened and do not know why someone would say that at all. R#2, informed LPA that she never allowed any guys in their room and R#1 is delusional. R#3 indicates he has never had any type of relationship with R#1, R#4 indicates he helped her set up an computer and has never had any relationship with her.
LPA requested and received the following documents of R#1: Identification Emergency information sheet, Admission Record sheet, last Physician report dated 7/31/2024, Appraisal dated 7/20/24, Needs and Service Plan dated 7/20/24 and Discharge paper from hospital dated 9/7/2024.

No citations were issued during this visit.

Exit interview conducted with Asst Administrator and a copy of this report was provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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