198603319-4-28-2025-11-AS-RORN-DH4L34-20250528082319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 04/28/2025
Date Signed: 04/28/2025 03:31:46 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
01/30/2025 and conducted by Evaluator Elvira Gonzalez

COMPLAINT CONTROL NUMBER: 11-AS-20250130081306

FACILITY NAME:	BEVERLY HILLS TERRACE		FACILITY NUMBER:	198603319
ADMINISTRATOR:	STRIKS, AHARON		FACILITY TYPE:	740
ADDRESS:	1470 S ROBERTSON BLVD		TELEPHONE:	(310) 273-3668
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	110	CENSUS: 54	DATE:	04/28/2025
		UNANNOUNCED	TIME BEGAN:	10:47 AM
MET WITH:	Cecilia Torres, Assistant Administrator		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff mismanaged resident's medication.

INVESTIGATION FINDINGS:

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On 04/28/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted a subsequent unannounced visit to further investigate and deliver findings for the above-named allegation. LPA met Assistant Administrator, Cesilia Torres, and the purpose of the visit was discussed. LPA was granted access into the facility.

The investigation consisted of the following:

On 02/05/25, LPA Gonzalez interviewed staff #1-#2 (S1-S2), witness #1 (W1) and resident #1 (R1). Additionally, LPA requested and received the following documents for R1: Facesheet, Physician's Report, Medication/PRN List, and the Medication Administration Record (MAR) for the month of January 2025. On 04/28/25 LPA Gonzalez reviewed resident files and their MARs. LPA requested and received the following documents: staff roster, resident roster, and Medication Administration Records (MAR) for three (3) residents the month of January 2025. LPA interviewed staff #3- #4(S3-S4) and residents #2-#6 (R2-R6). Furthermore, LPA and Assistant Administrator Cesilia Torres toured the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

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 3

Control Number 11-AS-20250130081306

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: BEVERLY HILLS TERRACE	FACILITY NUMBER: 198603319
	VISIT DATE: 04/28/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff mismanaged resident’s medication. It is being alleged that a resident from Garfield Terrace #198602243 who was temporarily staying at this facility, did not receive their medications as prescribed while they were at this facility. It is also being alleged that this facility is not organized with the resident’s medications. On 02/05/25 between 10:30 AM and 11:30 AM, LPA interviewed S1-S2, and on 04/28/25 between 11:45 AM and 12:30 PM, LPA interviewed S3-S4. Based on interviews conducted, 4 out of 4 staff interviewed stated that they have not mismanaged any residents’ medication. 4 out of 4 staff interviewed stated that no resident’s medications from Garfield Terrace were mismanaged during their temporary stay at this facility. 4 out of 4 staff interviewed stated that the resident’s medication is always kept organized and readily available for distribution. An interview conducted with S1 revealed that R1 did receive their medications as prescribed. S1 stated that there were no MARs for the residents from Garfield Terrace during their stay. S1 stated that the facility staff from Garfield Terrace came with and provided the medications for each of their residents, and that they administered the provided medications to the residents as prescribed.

On 02/05/25 LPA interviewed R1, and on 04/28/25 between 01:35 PM and 02:20 PM, LPA interviewed R2-R5. Based on interviews conducted, 5 out 6 residents interviewed stated they always received their medications as prescribed. 5 out 6 residents interviewed stated that the facility is organized with their medications and have not had an issue with their medications being distributed timely and as prescribed. 5 out 6 residents interviewed stated that they are not aware of a resident from Garfield Terrace not receiving their medications during their stay. 5 out 6 residents interviewed stated that they are satisfied with the services being provided to them at this facility.

LPA conducted records review of the Medication Administration Record’s for the month of January 2025 for three (3) residents and observed them to be complete and in order and did not observe any discrepancies.

Continued on LIC 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250130081306

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: BEVERLY HILLS TERRACE	FACILITY NUMBER: 198603319
	VISIT DATE: 04/28/2025

NARRATIVE

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Based on records review, interviews conducted and observations, LPA did not find sufficient evidence to support 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.

No deficiencies were cited during this investigation.

An exit interview was conducted with Assistant Administrator, Cesilia Torres, and a copy of the report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

LIC9099 (FAS) - (06/04)

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