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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609314
Report Date: 01/23/2025
Date Signed: 01/23/2025 02:39:10 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/20/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20250120231723
FACILITY NAME:BEIT SHALOM GROUP LLCFACILITY NUMBER:
197609314
ADMINISTRATOR:RUDES, MIRIAMFACILITY TYPE:
740
ADDRESS:1620 S SHERBOURNE DRIVETELEPHONE:
(213) 222-7598
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:6CENSUS: 6DATE:
01/23/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:ADMINISTRATOR MIRIAM RUDESTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff mishandled a resident's medication
Staff unlawfully evicted a resident
Staff is not meeting a resident's continence needs
Staff are not providing adequate transportation to medical appointments
INVESTIGATION FINDINGS:
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Community Care Licensing Division (CCLD) conducted an unannounced visit to Beit Shalom Group Facility on 01/23/2025 and was greeted by Administrator Miriam Rudes (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
The investigation consisted of the following: CCLD staff interviewed Administrator (S1), staff (S1-S3), residents (R1-R6). CCLD staff requested and reviewed copies of the following: Physician Report (dated 08/22/2023), Needs and Service plan (dated 09/01/2024), admission agreement (date 01/09/2025), incident reports (date 12/21/2025 to 1/8/2025), Medication administration record (MAR) (date 01/2025) for 1out of 6 residents. CCLD staff toured the facility with S1.
The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
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 4
Control Number 11-AS-20250120231723
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BEIT SHALOM GROUP LLC
FACILITY NUMBER: 197609314
VISIT DATE: 01/23/2025
NARRATIVE
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Regarding Allegation #1: Staff mishandled a resident’s medication.

It is being alleged that staff mishandled 1 out of 6 resident medications. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (date 12/13/2024), needs and service plan (date 12/23/2024), admission agreement (date 01/09/2025), incident reports (date 12/21/2024 to 1/8/2025), MAR (date 1/2025) for 1 out of 6 residents. CCLD staff reviewed resident MAR and could not find any medication errors. 3 out of 3 staff denied the allegation and staff indicate that staff has never had any issues with any resident medications. 3 out of 6 residents indicate no issues regarding medications. 3 out of 6 residents could not be interviewed due to cognitive issues.

Regarding allegation #2: Staff unlawfully evicted a resident.

It is being alleged that a staff unlawfully evicted 1 out of 6 residents. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (date 12/13/2024), needs and service plan (date 12/23/2024), admission agreement (date 01/09/2025) for 1 out of 6 residents. CCLD staff could not locate any eviction notice given to resident. 3 out of 3 staff denied the allegation and staff indicate that staff never evicted any resident. 3 out of 6 residents indicate that staff has never evicted them for cause. 3 out of 6 residents could not be interviewed due to cognitive issues.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 11-AS-20250120231723
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BEIT SHALOM GROUP LLC
FACILITY NUMBER: 197609314
VISIT DATE: 01/23/2025
NARRATIVE
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Regarding Allegation #3: Staff is not meeting a residents continence need.

It is being alleged that staff is not meeting 1 out of 6 residents continence needs. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (date 12/13/2024), needs and service plan (date 12/23/2024), admission agreement (date 01/09/2025) for 1 out of 6 residents. CCLD staff reviewed admission agreement for resident, facility states that incontinence supplies are not supplied by facility. Reviewed email between facility and resident conservator date 1/10/2025, email suggest that the facility will order supplies with insurance and resident family will need to pay for supplies not covered by insurance. 3 out of 3 staff denied the allegation and staff indicate that staff never had any issues with resident incontinence needs. 3 out of 6 residents indicate that they do not need incontinence supplies. 3 out of 6 residents could not be interviewed due to cognitive issues.

Regarding Allegation #4: Staff are not providing adequate transportation to medical appointments.

It is being alleged that staff are not providing 1 out of 6 residents transportation to medical appointments. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (date 12/13/2024), needs and service plan (date 12/23/2024), admission agreement (date 01/09/2025) for 1 out of 6 residents. CCLD staff reviewed admission agreement, page 1 section 2 “basic services”, indicates plan and arrange transportation to medical and dental appointments (paid by client), which was signed by resident conservator on 1/10/2025. 3 out of 3 staff denied the allegation and staff indicate that staff does not provide transportation for resident’s doctors’ appointments. 3 out of 6 residents indicate that staff does supply transportation for doctors’ appointments. 3 out of 6 residents could not be interviewed due to cognitive issues.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250120231723
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BEIT SHALOM GROUP LLC
FACILITY NUMBER: 197609314
VISIT DATE: 01/23/2025
NARRATIVE
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Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff mishandled a resident’s medication”, “staff unlawfully evicted a resident”, “staff is not meeting a residents continence need”, “staff are not providing adequate transportation to medical appointments” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Miriam Rudes S1.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4