<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603319
Report Date: 06/23/2025
Date Signed: 06/23/2025 02:43:04 PM

Substantiated


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
06/13/2025 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20250613163955
FACILITY NAME:BEVERLY HILLS TERRACEFACILITY NUMBER:
198603319
ADMINISTRATOR:STRIKS, AHARONFACILITY TYPE:
740
ADDRESS:1470 S ROBERTSON BLVDTELEPHONE:
(310) 273-3668
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:110CENSUS: 60DATE:
06/23/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Cesilia Torres, Assistant AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure facility is free from pests.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/23/25 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived and spoke to the Assistant Administrator, Cesilia Torres and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following:

On 6/23/25 LPA requested and reviewed copies of the following records: Resident Roster, Staff roster, and fumigation service records from Orkin for the last 3 months. LPA Shirley conducted a facility tour including the kitchen and rooms 228 and 229. LPA interviewed Staff 1 – Staff-9 and Resident 1 – Resident 6.


Con'd on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025
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 3
Control Number 11-AS-20250613163955
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: 06/23/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following:

Allegation: Staff did not ensure the facility was free from pests

On 6/23/25, LPA Felisa Shirley reviewed fumigation service reports from Orkin dated, 5/23/25, 4/11/25 and 3/27/25. Upon review of service reports, LPA Felisa Shirley observed that on all 3 reports the facility listed above has been treated for live activity of both cockroaches and bed bugs. LPA Shirley toured the facility with S9 and inspected room #229 and observed rust-colored splotches on the pillowcase of a resident. During the tour of the facility’s kitchen, LPA Shirley observed live activity.

LPA interviewed staff 1 – staff 9 (S-1 – S-9). LPA asked, does staff ensure that this facility is free from pest. Of those interviewed 9 out of 9 stated yes. LPA interviewed resident 1 – resident 6 (R-1 – R-6). LPA asked clients, does staff ensure that this facility is free from pest. Of those interviewed, 6 out of 6 answered, yes.

Based on CCLD staff's record review, observation and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title twenty-two (22), Division six (6), is being cited, please see attached LIC-9099D.



Deficiencies were cited during today's visit.

An exit interview was conducted, and plans of corrections were developed, with Cesilia Torres. A copy of this report and appeals rights were provided.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250613163955
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2025
Section Cited
CCR
80087(a)(1)
1
2
3
4
5
6
7
80087(a)(1) Buildings and Grounds
The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. The licensee shall take measures to keep facility free of flies and other insects
1
2
3
4
5
6
7
The licensee shall take measures to keep the facility free of bed bugs and other insects. Submit the written plan on how the facility will control the ongoing problem with bedbugs and roaches at the facility and in resident’s bedrooms by the POC due date of 7/7/25. Please forward copies of plan to LPA Felisa Shirley at felisa.shirley@dss.ca.gov or fax to 424-544-1016
8
9
10
11
12
13
14
Based on observations and interviews conducted, this facility has an ongoing problem with bed bugs and roaches. LPA Shirley reviewed service reports indicating treatment of live activity, LPA observed a live roach in the kitchen and a tour to room 229, LPA observed blood spots on the resident’s pillowcase which poses an immediate health and safety risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3