198603580-3-2-2023-28-AS-RORN-CPWU8Z-20230314152221

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603580
Report Date: 03/02/2023
Date Signed: 03/02/2023 12:43:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/24/2023 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230224122144

FACILITY NAME:	BEVERLY HILLS SENIOR CARE		FACILITY NUMBER:	198603580
ADMINISTRATOR:	DUFRENNE, PATRIA M.		FACILITY TYPE:	740
ADDRESS:	1015 S. ORANGE GROVE AVE		TELEPHONE:	(323) 933-8271
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90019
CAPACITY:	45	CENSUS: 43	DATE:	03/02/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jennifer Rivas		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility heater is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Assistant Administrator Jennifer Rivas and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Patria Dufrenne, Staff 1-3 (S1-3) and Resident 1-5 (R1-5). LPA collected copies of Staff and Resient Rosters. LPA also conducted a tour of facility including lobby, dining room, common areas on both 1st and 2nd floors, and a random selection of resident rooms.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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 28-AS-20230224122144

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603580
	VISIT DATE: 03/02/2023

NARRATIVE

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Investigation revealed the following: Regarding allegation, Facility heater is in disrepair, it is alleged that the heater of the facility's main floor has not been working for 3 or 4 weeks and the common areas which are the TV area/ dining area have heat from space heaters. During today's visit, LPA toured the facility and observed the facility heaters are working and observed that the facility's temperature on both floors was comfortable. LPA observed the temperature to be at 78 degrees. LPA observed the temperature to be set at a comfortable temperature for facility residents. Based on the statements obtained from the interviews conducted with Administrator and S1-3, LPA learned that the heater in the main lobby common area was out of order for approximately two weeks but during that time portable heaters were in use until the time the heater was repaired/replaced. The repair of the heater was stalled due to the increased rain and the repair not able to be completed until the rain subsided. Assistant Administrator purchased portable heaters and ensured that residents had heat when in the main floor TV/ Dining area. Heater located on the second floor was and is working properly. Heater located on the main floor (1st floor) working properly at the time of LPA visit. Administrator and S1-3 stated that heating in resident rooms was not affected. Interviews conducted with 5 out of 5 residents revealed that they do not have any concerns and that the facility contains a comfortable temperature at all times. 5 out of 5 residents stated that during the time the heater in the TV/ Dining room was not working the staff ensured that they had portable heaters in that room to ensure that a comfortable temperature was maintained for the residents.

Based on statements gathered from interviews conducted with facility staff, facility residents and LPA observations, there was not enough supportive evidence to concur with the reported 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 UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to Assistant Administrator Jennifer Rivas.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

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