197607801-3-9-2023-11-AS-MVAO-CQ6V64-20230322160855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607801
Report Date: 03/09/2023
Date Signed: 03/09/2023 02:47:40 PM

Unsubstantiated

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
10/18/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221018134543

FACILITY NAME:	BETTER LIVING & CARE II		FACILITY NUMBER:	197607801
ADMINISTRATOR:	LUCIEN EZROS		FACILITY TYPE:	740
ADDRESS:	622 N. HARPER AVENUE		TELEPHONE:	(323) 424-7052
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	6	CENSUS:	DATE:	03/09/2023
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Violetta Khalilova, Care giver		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff unlawfully evicted resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Violette Khalilova, Care Giver.

The investigation consisted of following: Interviews and Record reviews. On 10/24/2022, LPA Soto interviewed S#1-Lucien Ezros and S#2-Stella Ezros, administrators, S#3, (S#4 - S#6 via telephone), R#1 - R#3. The LPA also requested copies of the following documents on 10/24/2022, Face sheets, Resident and Staff rosters, R#1’s-( Admissions agreement, Resident Telecommunication Device Notification, Appraisals, Dual power of attorney, ID/Emergency information, vaccination-booster, consent to photograph and medical treatment, Personal rights, Physician's Report, Medication list. Dietary Menu, and Skilled nursing (Guardian) documents.)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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 11-AS-20221018134543

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: BETTER LIVING & CARE II	FACILITY NUMBER: 197607801
	VISIT DATE: 03/09/2023

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following. For Allegation – Staff unlawfully evicted resident. Interviews conducted with S#1 & S#2, communicated that R#1, was admitted to the facility on 10/06/22 and R#1 came to the facility from a skilled nursing facility. Administrator #2 evaluated R#1 at the skilled nursing facility and seemed like a good fit for the facility. The same night R#1 arrived, R#1 exhibited behaviors not disclosed to the facility. R#1 was exhibiting Dementia behaviors, such as: Sun downing, taking pamper off completely, and hanging out of the bed. R#1’s family took R#1 to a Urology doctor because R#1 came from the skilled nursing facility with a UTI. Family member claiming that R#1 behaviors were likely from the UTI R#1 had. The doctor communicated that R#1’s nightly behavior was from Dementia not the UTI. On 10/12/22, S#1, texted R#1 family member, let family member know that R#1 needed a higher level of care which the facility could not provide and R#1 needed to go to the hospital for the UTI. They volunteered to help find a new appropriate facility for R#1, were R#1 could be properly cared for because of R#1 Dementia extreme behaviors. Interviews conducted with S#3 – S#6, communicated that R#1 needed a lot of care. The staff had to be looking in on R#1 every hour to make sure R#1 was not falling or hanging from the bed, still had R#1 pamper on, and not trying to fall from R#1 wheelchair. R#1 would sleep during the day and slump over R#1 wheelchair because R#1 did not sleep during the night. Interviews conducted R#1 & R#3, could not communicate with LPA, R#1 was not able to communicate verbally and R#3, was not available for interview. R#2, communicated that R#2 has no issues with the facility. LPA reviewed R#1 - Physician’s report dated 10/03/22, it stated that R#1, needed basic assistance for bathing, eating, and help with changing clothes and diapers. The physician’s report also indicated that there was no sun downing or any other behavior which needed a higher level of care. Skilled nursing documents dated 10/03/22, showed that R#1 did have a UTI when R#1 was admitted to the facility. R#1 was admitted to the hospital on 10/17/22 and never returned to the facility per family member decision, R#1 was not illegally evicted. The interviews and records review did not concur with the above 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

An exit interview was conducted with Violetta Khalilova, Care giver and a hard copy of report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC9099 (FAS) - (06/04)

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