198603319-5-15-2025-11-AS-UCOL-DGWTGA-20250522144247

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 05/15/2025
Date Signed: 05/15/2025 09:54:10 AM

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
09/23/2024 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20240923141512

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: 56	DATE:	05/15/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Administrator Bella Naygas		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff neglect resulted in a resident to be hospitalized

INVESTIGATION FINDINGS:

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Community Care Licensing Division (CCLD) staff conducted an unannounced visit to Beverly Hills Terrace Facility on 05/15/2025 and was greeted by Administrator Bella Naygas (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.

The investigation consisted of the following: On 09/24/2024 CCLD staff interviewed Administrator S1, toured the facility and requested a copy of the Register of Resident Roster, Personnel Report LIC 500, Incident report (dated 08/26/2024), Admission Agreement (dated 08/23/2024), West Hollywood Healthcare and Wellness Center (dated 08/23/2024) and other documents pertinent to the allegation associated with this complaint. On 11/21/2024 CCLD staff interviewed R1’s primary doctor W1. On 11/22/2024 CCLD interviewed staff S2. On 12/11/2024 CCLD staff interviewed resident R1. On 11/24/2024 CCLD staff obtained a copy R1’s West Hollywood Healthcare and Wellness Center medical records.
The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

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-20240923141512

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: 05/15/2025

NARRATIVE

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Regarding the Allegation: Staff neglect resulted in a resident to be hospitalized.

It is being alleged that staff did not ensure resident received dialysis treatment causing resident to have a heart attack. Record reviews indicate the following: The facility admission agreement indicates that R1 was admitted to the facility on 08/23/2024. West Hollywood Healthcare and Wellness Center medical records indicates that R1 was sent to the hospital on 08/26/2024 due to unrelated medical conditions. On 08/27/2024 R1 had a fall while at the hospital, hospital staff checked R1 and R1’s pulse was low, R1 suffered a heart attack while at the hospital. Hospital records indicate the resident had numerous preexisting medical conditions affecting R1’s health. Interviews revealed the following: 2 out of 2 staff deny the allegation. S1 indicates on 08/24/2024 R1 was sick and refused to be taken to the hospital. R1 denied the allegation, R1 indicates that R1 has missed dialysis in the past and it has not led to heart attacks. R1’s doctor W1 reported that R1 had numerous medical issues and W1 indicated that R1 missing one day of dialysis did not result in R1 having a heart attack.

Based on interviews and supporting documentation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred therefore, the allegation of “staff neglect resulted in a resident to be hospitalized” 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 Bella Naygas S1.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025

LIC9099 (FAS) - (06/04)

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