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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603319
Report Date: 03/01/2022
Date Signed: 03/02/2022 09:26:29 AM


Document Has Been Signed on 03/02/2022 09:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



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: 72DATE:
03/01/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Bella NaygasTIME COMPLETED:
02:15 PM
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On 3/1/22, Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced Case Management- Legal/Plan of Corrections visit to the above facility regarding deficiencies issued on 2/17/22. LPA met with Bella Naygas-Administrator and explained the purpose of the visit.

During today’s visit LPA observed upon entry on the left side of the building, Covid-19 station. LPA observed screening visitor log book and hand sanitizer. LPA also elevator not operating with a sign in front that stated do not enter.

87468.1 (2) Personal Rights of Residents in All Facilities. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. On today’s visit the POC was cleared. On 3/1/22 at 12:00 PM LPA observed Covid-19 screening station visitors log book and hand sanitizer. LPA also observed in the office Covid-19 screening questions for staff.

87303 (a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

LIC-809 is on the next page.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/01/2022
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On today’s visit the POC was not cleared. On 3/1/22 at 12:05 PM LPA observed elevator was still not operating and signs were posted. LPA was informed at the time of visit plan of correction was sent requesting more time. LPA called and spoke with LPM Hammond and extension has been granted until 3/15/22.

An exit interview was conducted. “The licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.”

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022
LIC809 (FAS) - (06/04)
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