198603319-5-20-2021-11-AS-JHAD-C4XVHT-20210715162736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 05/17/2021
Date Signed: 05/20/2021 04:16:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/26/2021 and conducted by Evaluator Martessa Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210426131712

FACILITY NAME:	BEVERLY HILLS TERRACE		FACILITY NUMBER:	198603319
ADMINISTRATOR:	STRIKS, AHARON		FACILITY TYPE:	740
ADDRESS:	1470 S ROBERTSON BLVD		TELEPHONE:	(818) 293-2007
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	110	CENSUS: 75	DATE:	05/17/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Cliffor Johnson		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Martessa Brown conducted a subsequent visit in order to render investigation findings for the above allegation. During today’s visit LPA met with Clifford Johnson-Assistant Administrator and the purpose to the visit was explained.

The investigation consisted of the following: On 5/4/21, LPA Brown conducted a 10-day visit and toured the physical plant, interviewed Administrators and Resident R#1. LPA reviewed the following documents: Reviewed Personnel Report LIC 500 and Staff Roster, eviction notice and facility’s Plan of Operation. Reviewed residents R1 files: Emergency contact, Admission Agreements, Recent Appraisals, Physician Reports, Incident Reports and Medication Records.
Regarding allegation: Illegal Eviction.

LIC 9099C is on the next Page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021

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-20210426131712

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS TERRACE	FACILITY NUMBER: 198603319
	VISIT DATE: 05/17/2021

NARRATIVE

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Regarding allegation: Illegal Eviction.

On 4/2/21, LPA Brown investigated a previous complaint regarding the above allegation for Resident R#1. LPA reviewed the documents, conducted interview with Administrators and Resident R1. It was determining that Administrators did not follow procedures outlined in Title 22 and therefore complaint was substantiated. LPA informed Administrators to rescind a new eviction notice and follow outline procedures in Title 22. On 4/26/21, LPA received another complaint regarding the above allegation, Illegal Eviction for Resident R#1.

On 5/4/21 LPA interviewed the Administrator’s Clifford and Ella, they both stated R1 was given a 30-day notice that stated she was being evicted for breaking the house rules. They stated residents had several incident with assaulting staff and other residents in the facility. They also stated R1 makes false accusations against staff. They stated follow protocol in Title 22 and notified all agency and responsible party. They stated offered to assist R1 with finding a new place and R1 stated doesn’t want any assistance. LPA interviewed R1, she stated was given an eviction notice on 4/13/21 by Administrator. She stated the staff is making false accusation against her. She also stated doesn’t need any assistance with finding another place mentioned the facility will need to get an unlawful detainer.

On 5/14/21 LPA interviewed the Ombudsman, she stated asked R1 if she wanted to leave facility and if she could interview other residents? She stated R1 told her no and left. She stated R1 did not want to communicate with her regarding the evection

Based on investigation, interviews and documents, the Administrators followed Title 22 Procedure.

Although the allegations are valid or may have happened there is insufficient evidence to support the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021

LIC9099 (FAS) - (06/04)

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