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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603723
Report Date: 07/18/2025
Date Signed: 02/03/2026 10:01:50 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
06/11/2025 and conducted by Evaluator Luis DeLeon
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250611135715
FACILITY NAME:BEVERLY HILLS SENIOR CAREFACILITY NUMBER:
198603723
ADMINISTRATOR:ORDONEZ, DANAFACILITY TYPE:
740
ADDRESS:1015 S ORANGE GROVE AVETELEPHONE:
(323) 933-8271
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:45CENSUS: 44DATE:
07/18/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator Dana OrdonezTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff are not providing agreed upon items per the admission agreement.
Facility staff are not meeting residents’ nutritional needs
Staff is not safeguarding residents’ personal belongings
Staff are not ensuring the facility is free of pests
Staff are harassing a resident in care
Facility is not allowing resident payment options for monthly rent
Facility is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Luis De Leon conducted an unannounced subsequent complaint visit to deliver findings on the above allegations. LPA met with Administrator Dana Ordonez and explained the purpose of today's visit. LPA delivered findings to Administrator Dana Ordonez.

During the initial visit on 6/13/25, LPA obtained copies of the staff roster, client roster, Admission Agreements for residents R1-R4 including R1's placement agency notes, Physicians Report for residents R1-R4, Resident Personal Property and Valuables, Facility weekly food menus, invoices of food orders, and pest control invoices.



Report continues on page 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
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 7
Control Number 28-AS-20250611135715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 198603723
VISIT DATE: 07/18/2025
NARRATIVE
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During subsequent visit on 7/17/2025, LPA conducted interviews and conducted physical plant tour of common areas. LPA conducted five (5) staff interviews, five (5) resident interviews, and an interview with placement agency program associate. LPA obtained the following documents: R1’s monthly invoice, facility maintenance logs, pest control invoices, and R1’s admission agreement dated 04/05/2025.

During today’s visit, LPA obtained additional facility notes from Administrator which documents administration and staff interactions with R1.

Regarding allegation: Facility staff are not providing agreed upon items per the admission agreement.



It is alleged that it was agreed between Administrator, R1 and R1's placement agency that the placement agency would provide money to the facility to provide R1 with a television, and a refrigerator for R1's room for food as well as clothing and alleges the refrigerator was agreed upon because the facility would not meet R1's dietary needs. Investigation consisted of LPA interviewed five (5) residents, five (5) staff, one witness #1 (W1) and records review. The investigation revealed the following: The administrator denied making offers for a television and a refrigerator as part of the initial placement agreement for R1. LPA reviewed the admission agreement and there was no statement indicating a television or refrigerator was offered. Four (4) out of five (5) staff stated that they are not aware of initial administration conversations with prospective residents with offers of facility providing items such as television and/or refrigerator. Interviews with R2, R3, and R5 revealed that items such as television or refrigerator had been provided by previous facility owner, or items were already in the room when residents initially moved in, or was donated by resident’s family. LPA interview with witness #1 (W1) revealed that R1's placement agency does not provide or offer items such as television and/or refrigerator. W1 stated that W1 does not believe R1's placement agency staff would make such an offer; otherwise, W1 would have heard about it. W1 stated that placement agency requests clothing from facilities, if facility has any available; otherwise, residents can buy clothing using their Personal and Incidental Allowance (P&I money). Administrator stated that a mini-fridge was provided to R1's room; however, R1 was not satisfied with the refrigerator size. Based upon the investigation, residents, witness, and staff interviews, document review, and LPA observations, facility and/or R1's placement agency did not make any offer during initial resident placement for items such as television and/or refrigerator.

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SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 28-AS-20250611135715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 198603723
VISIT DATE: 07/18/2025
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Regarding allegation: Facility staff are not meeting residents’ nutritional needs.

It is alleged that the facility would not be able to meet R1’s dietary needs. It is alleged that the facility’s food alternatives were not going to meet R1 needs. It is alleged that the facility’s food alternatives were not going to meet R1 needs so they all agreed on a fridge so that meals on wheels could drop off R1’s food and be kept in R1’s room. Investigation consisted of LPA interviewed five (5) residents, five (5) staff, and one (1) witness (W1). LPA reviewed the admission agreement, physician’s report, facility’s weekly food menu, and alternative food menu. LPA obtained from the facility a kitchen menu where kitchen staff has resident’s modified food diet, where R1 is included. Interviews with residents revealed that four (4) out of five (5) residents had no issue with food served at the facility. R3 shared that staff is accommodating when requesting meal changes to manage R3’s weight. LPA interviews with staff revealed that Administrator received a specific food request from R1 for R1's diet which included Salmon, Steak, Chicken, Tuna, Turkey, Lentils, Vegetables, and fruits. Food to be excluded from his food diet: pasta, pork, and bread. LPA reviewed physician’s report for R1 and observed no reference to R1 having a modified diet. LPA interview with staff revealed that three (3) out of five (5) staff stated that, for each meal and two hours prior to serving meal, staff approaches residents to inquire if residents wish to make changes to the meal offered to residents. The staff communicates residents request for kitchen to prepare meals. Interview with S4 revealed that R1 requested from S4 not to offer breakfast because R1 doesn’t do breakfast. Later S4 observed R1 requesting breakfast from another staff. In addition, S4 stated that S4 has not received any request from R1 choosing meal from the alternative food menu. LPA observed R1 room refrigerator with own meals that R1 prepares own meal using the dining room’s microwave. LPA interview with W1 revealed that R1's placement agency did not offer to obtain assistance in obtaining food from meal on wheels and did not believe R1's placement agency staff would make that promise to residents; otherwise, W1 would have heard about request for meals on wheels from placement agency staff. Based upon the investigation, residents, witness, and staff interviews, document review, and LPA observations, facility is meeting residents’ dietary needs as documented on resident’s physicians’ orders and following food menu planning.

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SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 28-AS-20250611135715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 198603723
VISIT DATE: 07/18/2025
NARRATIVE
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Regarding allegation: Staff is not safeguarding residents’ personal belongings.

It is alleged that the facility staff is not safeguarding residents’ personal belongings and, as a result, R1 has had items missing or damaged in R1’s room. Investigation consisted of LPA interviewed five (5) residents and five (5) staff and reviewed documents. LPA interviews with four (4) out of five (5) residents denied having any property lost or damaged for all the time that residents have been residing at facility. One staff mentioned that there have been some instances where laundry has been mixed up, but it was sorted out. R4 stated that when attending the day program, R4 has left the room open and did not have any items lost or damaged. Five (5) out of five (5) staff denied hearing any resident’s complaint about items lost or damaged. One staff member stated that R1 requested from day one not to enter room and observed that R1 barricades door and prevents anyone from entering room. LPA experienced on previous visit that R1 prevented LPA and Administrator from going into room when R1 was not on premises. LPA observed objects on door preventing anyone from accessing the room. LPA obtained records indicating that R1 had previously prevented an electrician and the exterminator from entering the room. Based upon the investigation, residents, staff interviews, document review, and LPA observations, the facility is safeguarding residents’ personal belongings.

Regarding allegation: Staff are not ensuring the facility is free of pests.

It is alleged that the facility is infested with roaches and spiders in all common areas and residents’ rooms and that facility is failing in ensuring that facility is free of pests. Investigation consisted of LPA interviewed five (5) residents, five (5) staff and reviewed documents. Administrator explained that the facility has a service agreement with a pest control company for monthly treatment and the facility may call pest control as per need basis. Administrator stated that on each monthly visit, the facility provides various rooms to be fumigated. The service agreement includes service control for roaches, ants, and spiders. Interview with residents revealed that four (4) out of five (5) residents have observed roaches. Three residents observed roaches in their rooms and one resident observed roaches coming out from the elevator shaft.

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SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 28-AS-20250611135715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 198603723
VISIT DATE: 07/18/2025
NARRATIVE
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Three (3) out of four (4) residents stated that the facility took care of incidents by fumigating the affected area. Residents have observed exterminators frequently spraying around facility rooms and common areas. Interviews with staff revealed that three (3) out of five (5) staff have seen roaches in the rooms or the kitchen area. Staff stated that in all instances fumigation was done and have not seen any roaches since then. During physical plant tour, LPA observed roaches on R1 room only and did not observe any roaches on any other resident’s room, kitchen or common facility area. Administrator provided contemporaneous notes for R1’s interaction and noted that on 4/23/28 and 5/28/25, R1 denied access to pest control exterminator to treat R1’s room. Based upon the investigation, residents, staff interviews, document review, and LPA observations, the facility is making effort to maintain the facility free of pest and provided documentation of pest control monthly visits since 10/23/24.

Regarding allegation: Staff are harassing a resident in care.
It is alleged that the facility staff is harassing R1 by taking away items from the room, cigarette burns on table and on the mattress. R1 alleges discrimination based on R1's age and color. R1 alleges that another African American resident in care was also harassed because of color and because resident broke toilet. Investigation consisted of LPA interviewed five (5) residents, five (5) staff, and witness #1 (W1). Interview with residents revealed that four (4) out of five (5) denied being physically or verbally harassed by staff. Two (2) out of four (4) residents denied being harassed by staff because of their race and all stated that they were happy to be at the facility. LPA observed during R1 interview that R1 becomes combative when discussing allegations. R1 accused LPA of harassing R1 as well. In addition, the interview with W1 described a similar experience when placement agency staff tried to meet with R1 to discuss services and, as 07/18/2025, placement agency staff has not been able to speak with R1. Interviews with staff revealed that five (5) out of five (5) staff denied the allegation above. Staff described administration reminders during staff meetings to be always nice and respectful to residents. Three (3) out of five (5) staff denied entering R1’s room or removing or damaging R1’s belongings. Based upon the investigation, residents, staff interviews, witness interview, and LPA observations, the facility staff was not found to be harassing residents in care.

Report continues on page 9099C...
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 28-AS-20250611135715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 198603723
VISIT DATE: 07/18/2025
NARRATIVE
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Regarding allegation: Facility is not allowing resident payment options for monthly rent.
It is alleged that the facility does not allow resident payment options for monthly rent and that facility refuses payment in the form of money orders. It is also alleged that the Administrator requests payment in cash. Investigation consisted of LPA interviewed five (5) residents, five (5) staff, and document review. LPA review of admission agreement revealed that agreement states that rent payment can be made in the form of checks and/or money orders under the section of “Payment Provisions.” Administrator stated that even though the admission agreement does not state that cash is accepted, the cash option is also available for private pay residents. Administrator stated that residents have payment options for monthly rent. Interview with four (4) out of five (5) residents revealed that none have had any issues with making the monthly rent payments. All four stated that they are not aware of how payments are made since rent payments are directly made by SSI or other social service agencies. Interviews with staff revealed that four (4) out of five (5) staff are not aware of how payments are made to administration. Based upon the investigation, residents, staff interviews, witness interview, and document review, the facility does offer payment options in the form of check, money order and cash.


Regarding allegation: Facility is in disrepair
It is alleged that the facility and a resident's room are in disrepair. Resident alleges that the lock to resident's room is broken, there are holes that are not patched on the wall, there are wall holes from nails that have not been patched, pest dropping, mattress cover is torn and burned, and floor molding is loose. Investigation consisted of LPA interviews with five (5) residents, five (5) staff, physical plant tour, and document review. LPA observed during the physical plant tour that there were no health and safety risks in residents’ rooms and/or common areas. LPA observed a water leak under the sink of a resident’s room that was reported to the administrator. LPA observed that R1’s room had various nail holes on walls, unpainted wall patch, torn and cigarette burn mattress covers, and dirty floor molding.

Report continues on page 9099C...

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 28-AS-20250611135715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: BEVERLY HILLS SENIOR CARE
FACILITY NUMBER: 198603723
VISIT DATE: 07/18/2025
NARRATIVE
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Interviews with four (4) of out five (5) residents revealed that none have observed any issues with their rooms or common areas. All residents stated that staff maintenance quickly responds when issues are reported for repairs in their rooms. A resident stated that administration keeps up the facility. Interviews with staff revealed that five (5) out of five (5) staff denied the allegation above. Five (5) out of five (5) staff stated that repairs to R1’s room is not possible since R1 refuses to provide access to room. Administrator contemporaneous notes indicate that on 4/23/25, R1 refused to allow electrician to R1 room. On 4/7/25, R1 indicated that no one was allowed in the room and R1 would do own cleaning and changing of the bed linen and sheets. S2 stated that from day one, R1 requested that S2 not enter R1’s room. Staff described administration responding quickly to requests for repairs. Staff described an instance where a toilet tank broke inside a resident’s room, and it was repaired the same day. On another instance, windows screens fell off from the dining room but were immediately repaired. LPA reviewed maintenance logs for facility and observed repair request since November 2023. An interview with maintenance staff (S3) revealed that S3 is responsible for repairing minor jobs throughout the facility. However, if a job requires a professional service, administration places call for repair services. Administrator provided invoices for recent repairs made by commercial contractors. R1 allowed maintenance staff (S3) to come to R1’s room with LPA to take note of repairs needed to be done in R1’s room, R1 immediately started accusing S3 to be the problem and harassing R1. LPA explained that S3 needed to take notes for repairs and repairs would be scheduled. Based upon investigation, residents, staff interviews, document review and observations, the facility does not appear to be in disrepair and does not pose any health and safety risk.

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 held with Dana Ordonez. A copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7