198603319-7-2-2021-11-AS-MVAO-C6ES7D-20210831133718

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 07/02/2021
Date Signed: 07/02/2021 02:30:43 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
12/28/2020 and conducted by Evaluator Troy Agard

COMPLAINT CONTROL NUMBER: 11-AS-20201228104407

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: 81	DATE:	07/02/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Clifford "Cliff" Johnson		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident does not have access to telephone.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 07/02/2021 Licensing Program Analyst (LPA) Troy Agard initiated a subsequent investigation for the allegations listed above. LPA Agard conducted a risk assessment questionnaire at the front entrance of the facility. LPA arrived at the facility at 11:32am and was toured by Caregiver, Yuvicsa Tomsino. LPA explained the purpose of the investigation was to investigate the allegation listed above.

The investigation consisted of the following:

On 01/05/2021 Licensing Program Analyst (LPA) Troy Agard, initiated a complaint investigation for the allegation listed above. Due to the situation surrounded Coronavirus (Covid 19), and to implement mitigation measures, the initial 10-day visit was conducted via FaceTime with Assistant Administrator, Clifford “Cliff” Johnson. LPA Agard explained the purpose of this visit is to gather information regarding the complaint allegation.
Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

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 2

Control Number 11-AS-20201228104407

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: 07/02/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA Agard conducted a FaceTime tour of the facility grounds and an interview with the Assistant Administrator. LPA Agard requested the following documents be sent on or before January 12, 2021. A copy of the staff roster, a copy of the client roster and their responsible party.
On 07/02/2021, LPA Agard conducted a visit to the facility, to deliver findings in person.

Regarding the allegation: Resident does not have access to telephone. It’s being alleged a resident is not receiving their calls.

On 07/02/2021 LPA completed a walkthrough of the facility and spoke with Caregiver, Yuvicsa Tomsino. LPA checked the facility phone on the first and second floor. They were both observed in working order. LPA Agard observed a pay phone in the hallway, on the first floor of the facility that was not in working order.

During interviews with staff, it was revealed: S1 states the clients have access to the landline. “We usually page them when they have a call if we don’t see them then we knock on their door. If they don’t answer we take a message.” S1 states the clients prefer to use the free landline over the payphone. S2 states, “they have access to the phone line 24/7.” LPA Agard verified phone was in working order by calling the facility phone from inside.

During interviews with residents, it was revealed 8 of the 8-residents interviewed all stated having access to the phone. All reported being able to receive their calls and make calls whenever they needed. C1 states, no issues, C2 states getting calls from their brother and not having any issues. C3 states they “pretty much” get all his calls. C4-8 all agreed that there were no issues with making and receiving calls.

Based on LPA’s observation, interviews conducted, the preponderance of evidence standard has not been met. 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.

Exit interview conducted, and a copy of the report was left with Assistant Administrator, Clifford “Cliff” Johnson..

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2