Inspection visit

Follow-up on correctionsJune 22, 2021

BELMONT VILLAGE HOLLYWOODLicense 1976084672 citations on this visit

2 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPAs) Gary Tan, LaQueena Lacy and Licensing Program Manager (LPM) Naira Margaryan conducted an unannounced case management follow up visit regarding the incident occurred 03/31/2021. Woodland Hills South Adult and Senior Care Regional Office (WHASCRO) received an incident report involving the facility resident #1 (R1). As per Incident report on 03/31/2021, R1 fell and injured R1’s Right Shoulder. Subsequently R1 required hospitalization and had a surgery, as the fall resulted fractured clavicle and humerous. On 04/09/2021 the incident was investigated by the case carrying LPA. LPA investigation included interviewing residents, staff, and other relevant parties, reviewing R1's facility file, medical records and other relevant documents. Investigation revealed that on 03/31/2021 on or after 5:30pm, facility staff #1 (S1) went to assist R1 and observed R1's hands and face covered with feces. Before transferring R1 from the wheelchair to bed to clean R1, S1 left R1 on the wheelchair, removed footrests and walked out from the room to ask for assistance. By the time S1 returned, R1 was on the floor laying on right shoulder parallel to the bed. S1 pulled R1 from the floor and assisted R1 back to bed by lifting and holding R1 under R1's arms. As per medical professionals interviewed during investigation, lifting and holding R1 under R1 arms could contribute to the injuries resulted from fall. At the time of this visit at 3:30 PM, LPAs explained the findings to the Resident Care Services Director. (continued on LIC 809-C) (continued from LIC 809) Based on interviews, inspection, observation and record review, it was concluded that: 1. R1 fell due to being left untended on the wheelchair with no footrest, while staff went to ask for assistance. 2. R1 was not assessed for pain prior to moving them from the floor to bed. 3. R1 complained of pain after staff lifted R1 from the floor and assisted back to bed by pulling and holding R1 under R1's arms. Details of investigation was documented on previous Licensing visit conducted on 04/09/2021 at which time, the Executive Director (ED) was informed that all noted deficiencies will be cited and immediate $500.00 civil penalty will be issued to the facility. In addition, ED was informed that upon further analysis conducted by the department, an additional civil penalty might be assessed, based on Health and Safety Code 1548. Under Title 22, Division 6, Chapter 8, following deficiencies were cited and recorded on LIC 809 D Exit interview conducted. A copy of the report was issued. Appeal rights provided.

Citations

7 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

87464(d)Type A
Acceptance obligations tied to pre-admission appraisal needs
A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing basic services specified below... This requirement is not met as evidenced by:Based on interviews and record reviewthe Licensee did not ensure that the resident was supervised as required. R1 fail and sustained of injuries due to being left unattended. This poses an immediate health and safety hazard to residents in care.
87464(f)Type A
Basic services shall at a minimum include: (1) Care and supervision; as per H & S Code 1569.2(c). the facility assumes responsibility for or provides ongoing assistance with activities of daily living without which the resident’s … health, safety, or welfare would be endangered. This requirement is not met as evidenced by:Based on interviews and record review the licensee did not provide required assistance to the resident after the fall. This poses an immediate health and safety hazard to residents in care.
87303(a)Type B
Maintain facility in clean, safe, sanitary condition
Based on LPAs observation during the physical plant tour, grab bars in the some room and dresser in room 101 was broken, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
87303(e)(2)Type A
Provide resident hot water for personal care
Based on observation the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Cleared during visit.
87309(a)(1)Type A
Store disinfectants separately from food supplies
Based on LPAs observation during the physical plant tour, the licensee did not comply with the section cited above poses an immediate health, safety or personal rights risk to persons in care.
87608(a)(3)Type B
Maintain physician order documentation in resident record
Based on LPA observation during physical plant tour, resident on room 225 has half bed rail without doctor's order, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
87608(a)(5)(B)Type A
Based on LPAs observation during physical plant tour Resident on room 338 has full bed rails, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the June 22, 2021 inspection of BELMONT VILLAGE HOLLYWOOD?

This was an other inspection of BELMONT VILLAGE HOLLYWOOD on June 22, 2021. 2 citations were issued: 2 Type A (serious).

Were any citations issued to BELMONT VILLAGE HOLLYWOOD on June 22, 2021?

Yes, 2 citations were issued (2 Type A, 0 Type B). The first citation was for: "A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular reside..."

What type of inspection was this?

This was an other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated June 15, 2026. If you believe any information is inaccurate, report it here.

Follow-up on corrections·June 22, 2021