Belmont Village Hollywood.

The complaint was referred to the Investigations Branch, (IB) of the Community Care Licensing Department (CCLD) and accepted for full investigation. An investigation was continued and completed by Senior Investigator, (SI) Philippe Ryan Miles. On 7/23/25, at 1:50 pm, SI spoke with R1. On 8/19/25, at 1:50 pm, and on 8/27/25, at 6:45 am, SI interviewed S1 and S2 respectively. On 7/22/25, SI reviewed facility records obtained during LPA's initial visit. The following is a summary of the complete investigation: On 07/07/25, LPA’s interview with the Administrator revealed the following: Administrator refutes the allegation. R1 has progressive and frequent episodes of confusion and forgetfulness. S1 and S2 were interviewed by the Administrator, and at the time the alleged incident occurred, S1 was accompanied by S2 when they checked on R1. S2 verified to the Administrator that S1 never placed their hands in R1's pants. SI’s interviews with Staff revealed the following: Both S1 and S2 refute the allegation. S1 denied having any physical contact with R1, nor putting their hands down R1's pants. S2 witnessed S1 having no physical contact with R1,and stated that S1 never touched R1 in a non-appropriate way. SI interviewed R1 who denied being touched by S1 on their private area but recalled S1’s hands being in R1’s pants. Records review conducted by LPA Comer, and SI Miles corroborated the information revealed by the Administrator. Records also revealed that the alleged incident was reported to R1's Physician, Responsible parties and Licensing agency. Based on interviews and record review, there is not sufficient information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit Interview conducted, and a copy of this report was given to the Administrator.

Allegation: Due to lack of supervision, resident eloped from the facility . It was alleged that resident #1 (R1) was found on the street sitting down on the sidewalk. R1 was found by a couple walking on the street. Suspecting that R1 was a resident of the facility, staff were contacted. R1 was identified and returned back to the facility. LPA interviews with the Administrator and Staff verified the following: On the evening of 4/8/25, R1 eloped from the facility via a courtyard door located in the enclosed patio. An audio alarm alerted staff that the door had been opened. However, staff could not identify which patio door was open. At around 10:00 pm, staff was alerted by an unknown individual that R1 was sitting on the sidewalk, near to the facility. R1 was returned to the facility with staff assistance. A review of records verified that R1 cannot leave facility unassisted. Incident report previously submitted to the licensing office also supported the information revealed by interviews. Based on interviews and records review, there is sufficient information and evidence to support the allegation. Therefore, the allegation is substantiated at this time. The citation was issued and recorded on LIC9099D. An immediate civil penalty of $500.00 also was issued to the facility at the time of this visit. Exit interview was conducted and a copy of report was issued.

LPA also obtained and reviewed additional documentation pertinent to the allegation. According to the complaint, R1 requests wine during evening meals, which may have caused R1 to fall and remain on the floor overnight until the following morning. Interviews with staff reported R1 may have a drinking problem and are permitted to consume wine served during dinner. Staff stated R1 is independent and that the facility cannot force R1 to stop drinking. It was further reported that R1 orders wine independently and that friends bring wine during visits. LPA interviewed R1, who denied remaining on the floor overnight until the following morning. R1 reported wine is served at dinner and that R1 consumes it but denied having a drinking problem and denied that alcohol consumption caused any falls in R1’s room. Interviews with residents indicated the facility serves alcohol and allows residents to drink at their discretion. Residents reported observing other residents consuming excessive amounts of alcohol but stated it was not their concern. Based on interviews conducted and observations made, there is insufficient evidence to substantiate that facility staff failed to prevent a resident from engaging in self-harm. Therefore, the allegation is Unsubstantiated at this time. Allegation #2: It was alleged that facility staff did not address a resident’s change in medical condition. To investigate the allegation, on 01/23/2025, from 10:30 a.m. to 3:30 p.m . , (LPA) Raymond Cromer conducted an initial complaint visit to gather evidence and obtain facility documentation and resident records related to the allegation. On 05/12/2025, from 12:00 p.m. to 2:00 p.m., LPA Cromer conducted a subsequent visit to obtain additional information. On 09/22/2025, from 10:20 a.m. to 2:15 p.m . , LPA Tuesday Cabiness conducted an additional visit, during which interviews were conducted with four (4) staff members, Resident #1 (R1), nine (9) residents out of ninety-five (95 ) , and other witnesses involved with the complaint. LPA also obtained and reviewed resident records, and facility documents pertinent to the allegation. Information obtained through interviews indicated that R1 experienced multiple falls and had bathing and hygiene issues. It was reported these factors contributed to wounds on R1’s leg. Review of R1’s home health records revealed that R1 has chronic venous ulcers and received treatment for the wounds from May 2024 through September 2025. Review of facility documentation regarding R1’s medical condition revealed that In November 2024, an updated resident service plan was implemented documenting that R1 was independent, did not require assistance with activities of daily living (ADLs), and was receiving home health services for treatment of wounds on R1’s legs related to R1’s medical condition. ( Cont'd LIC9099C) 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 In January 2025, R1 experienced a fall and was having pain in R1’s legs, which caused R1 to be hospitalized, after which R1 was admitted to a skilled nursing facility and did not return to the facility until March 2025. Upon R1’s return, a new physician’s report was completed. In April 2025, the facility updated R1’s assessment plan to reflect the significant changes in R1’s health condition. Based on the information obtained, LPA determined the facility addressed R1’s change in medical condition by completing updated assessments and maintaining a current physician report. Therefore, there is insufficient evidence to support the allegation that the facility failed to address R1’s change in medical condition. The allegation is deemed to be Unsubstantiated at this time. Allegation #3 : It was alleged that resident developed multiple pressure injuries while in care. To investigate the allegation, on 01/23/2025, from 10:30 a.m. to 3:30 p.m . , (LPA) Raymond Cromer conducted an initial complaint visit to gather evidence and obtain facility documentation and resident records related to the allegation. On 05/12/2025, from 12:00 p.m. to 2:00 p.m., LPA Cromer conducted a subsequent visit to obtain additional information. On 09/22/2025, from 10:20 a.m. to 2:15 p.m . , LPA Tuesday Cabiness conducted an additional visit, during which interviews were conducted with four (4) staff members, Resident #1 (R1), nine (9) residents out of ninety-five (95), and other witnesses involved with the complaint. LPA also obtained and reviewed resident records, and facility documents pertinent to the allegation. Based on interviews and documentation reviewed, R1 was reported to be prone to falls due to slipping from the wheelchair. It was further reported that R1 experienced difficulty transferring from the bed, which caused pain in R1’s legs and impaired R1’s ability to stand. Review of R1’s medical history and documented decline in health revealed that R1 has chronic venous ulcers. Records indicated R1 received home health services for wound care from May 2024 through September 2025 due to wounds on the body. During an interview with LPA, R1 reported that the wounds were caused by the wheelchair. R1 further reported that both home health providers and facility staff provided medical treatment and assistance to support healing of the wounds. (Cont'd LIC9099C) 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 Documentation reviewed also indicated that R1 was admitted to a skilled nursing facility for several weeks due to R1’s declining health condition, wounds, and inability to stand. Based on interviews and documentation reviewed, there is insufficient evidence to support the allegation that R1 developed pressure injuries while in care. The allegation is determined to be Unsubstantiated at this time. Exit interview conducted, and copy of report provided to Director of Residential Care Services.

Licensing Program Analyst, (LPA) Raymond Comer, made an unannounced site visit to this facility as a continuation of the Required 1 Year Annual Inspection conducted on 10/09/2025. LPA met with Administrator, Janelle Topete, and the purpose of visit was disclosed. The following remaining inspection domains were observed, reviewed and inspected : MEDICATIONS : Medication Room is located on the third floor. Medication room is secured and inaccessible to residents. Medications for three residents were counted and Medication Records were reviewed for proper documentation and administration. First aid kits appeared as fully stocked, with first aid manual. OUTDOORS : Courtyard areas observed to have shaded patio(s), with tables with sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans were observed to be covered. There are no bodies of water in the facility. STAFF RECORDS: Staff files are stored in Administrator's office located on the third floor. Records are secured and inaccessible to residents. Staff files were reviewed for criminal record clearances, Health Screening, staff associated to this facility, and other required documentation. Staff records appear to be complete and current. RESIDENT RECORDS: Resident files are stored in Administrator's office located on the third floor. Records were reviewed for current IPP and/or Needs and Services plans, physician report, admission agreements, and other required documentation. Resident records appeared to be complete and current. 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 There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was given to the Administrator.

On 10/09/25, 10:00 am, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct an unannounced inspection of the Facility. LPA met with Resident Care Director, Nathaniel Akyempon, and reason for the visit was disclosed. Administrator's Certificate is valid; expiration date: 10/05/2026. Facility is licensed as a four story complex, maintaining resident bedrooms with private bathrooms, and multiple public bathrooms. Fire clearance approved for (125) non-ambulatory, and an additional twenty-five (25) bedridden. Hospice waiver approved for fifteen (15) residents. At the time of this inspection, no residents were receiving hospice care services, and no bedridden residents. At 10:25 am, LPA toured the physical plant and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main doors are the primary entry/exit point, including four (4) emergency exits: Two exits off the northeast and northwest corners of the facility, one exit off the south corner, and one exit off the southeast corner. Screening area is located immediately upon entrance. Visitor sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, and other necessary signage are posted throughout the facility. Facility is separated into Independent/Assisted Living, (second, third, fourth floors) and Memory Care. (First Floor) As the Facility provides dementia care, LPA observed the delayed egress system working properly. Room temperature is comfortable; wall thermostat displays a setting of 74.0°F., within the required range. Required postings are prominently displayed and observed as current. [Continued on LIC 809-C] 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 FIRE SAFETY: Fire detection system is present in the facility. LPA observed multiple smoke and carbon monoxide alarms installed, hardwired, and interconnected. Fire system monitoring is serviced on a monthly basis. Fire alarm system was tested and working properly. Fire drill was last conducted in Sept, 2025. Fire extinguishers were observed on all floors of the Facility. All extinguishers were last serviced on 2/19/2025. Roof access is inaccessible to residents. Evacuation routes are clearly labelled and posted throughout the facility. LPA observed evacuation chairs in facility stairwells. KITCHEN: At 11:10 am, LPA observed kitchen to be clean, with an adequate supply of perishable and non-perishable foods located in the refrigerator, freezer, and pantry. LPA observed a variety of fresh fruits, vegetables, meats, dry cereals, and desserts. Foods are properly labeled and stored. Knives and sharps are stored in a designated area of the kitchen and inaccessible to residents. LAUNDRY: LPA observed laundry rooms located all floors for residents to launder their personal clothing; with the exception of the first-floor Memory Care Unit. Laundry areas were clean and clear from obstruction. Facility bed linens, towels, etc. are serviced by contracted laundering vendor. BEDROOMS: LPA conducted random observations of resident bedrooms (#105, #222, #234, #305, #319, #321, #412, #414, #416) for safety, privacy, and comfort. Bedrooms were inspected and observed to maintain required furnishings and sufficient lighting, bed linens, and blankets. All observed bedrooms were clean, free of odor, and clear of obstruction. B ATHROOMS: were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured between 108.0°F. and 116.0°F.; within the required range. COMMONS: LPA inspected activity rooms, movie theater, salon, wellness centers, gym, library, dining rooms, and reception areas. Common areas were observed to be clean with adequate furnishings for resident use. Furnishings are in good condition. No obstructions, nor tripping hazards observed. Due to time constraints, LPA was unable to complete the required Annual inspection visit. LPA will complete at a later date. Exit interview conducted/Copy of report was provided.

Licensing Program Analyst, (LPA) Raymond Comer, made an unannounced site visit to this facility as a continuation of the Required 1 Year Annual Inspection conducted on 07/01/2024. LPA met with Director, Nathaniel Akyempon, and the purpose of visit was disclosed. The following remaining inspection domains were observed, reviewed and inspected : Fire Safety: Fire Detection/Protection system is present in the facility. LPA observed multiple smoke and carbon monoxide alarms installed, hardwired, and interconnected. Fire system back up and tests are completed and documented on a monthly basis. Fire Alarm System was tested and working properly. Fire drill last conducted 6/12/2024. Fire extinguishers were observed on all floors of the Facility. All extinguishers were last serviced on 2/08/2024. Roof access is inaccessible to residents. Evacuation routes are clearly labelled and posted throughout the facility. LPA observed evacuation chairs in all stairwells of the facility. Kitchen: At 1:30 PM , LPA observed kitchen to be clean, with an adequate supply of perishable and non-perishable foods located in the refrigerator, freezer, and pantry. LPA observed a variety of fresh fruits, vegetables, meats, dry cereals, and desserts. Foods are properly labeled and stored. Knives and sharps are stored in a designated area of the kitchen. Kitchen is secured and inaccessible to residents. Medications : Medication Room is located on the third floor. Medication room is secured and inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. First Aid kits are complete. [Continued on LIC 809C] 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 Laundry: At 2:00 pm. LPA observed laundry rooms located on each floor. Residents have access to do their own laundry. Laundry area is clean and clear from obstruction. Cleaning supplies, and other toxins, are securely stored and inaccessible to residents. Commons: LPA inspected activity rooms, movie theater, salon, wellness centers, gym, library, dining rooms and reception areas. Common areas were observed to be clean with adequate furnishings for resident use. Furnishings are in good condition. No obstructions, nor tripping hazards observed. Bedrooms: LPA observed resident bedrooms and bathrooms on all four (4) floors for safety, privacy, and comfort. Bedrooms were inspected and observed to maintain required furnishings and sufficient lighting, bed linens, and blankets. All bedrooms were observed to be clean and clear of obstructions. Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 118.0°F. Within the required range. Outdoor : Courtyard area observed to have a shaded patio, with tables with sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans were observed to be covered. There are no bodies of water in the facility. There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was given to facility Staff Director, Nathaniel Akyempon.

On 07/01/24, 9:45 AM, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct an unannounced inspection of the Facility. LPA met with Administrator, Janelle Topete . Facility is licensed as a four story complex, maintaining resident bedrooms with private bathrooms, and multiple public bathrooms. Fire clearance approved for (125) non-ambulatory, and an additional twenty-five (25) bedridden. Hospice waiver approved for fifteen (15) residents. At the time of this inspection, there are four (4) residents receiving hospice care services, and no bedridden residents. At 10:15 AM , LPA and the Administrator toured the physical plant and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main doors are the primary entry/exit point, with four (4) emergency exits: Two exits off the Northeast and Northwest corners of the facility, One exit off the South corner, and One exit off the Southeast corner. (Dining room) Emergency exit routes are clear of obstructions. Screening area is located immediately upon entrance. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, and other necessary signage are posted throughout the facility. Facility is separated into Independent/Assisted Living, (Second,Third and Fourth Floors) and Memory Care. (First Floor) As the Facility provides dementia care, LPA observed the delayed egress system working properly . Room temperature is comfortable; wall thermostat displays a setting of 73.0°F., within the required range. Administrator's Certificate is valid with expiration: 10/5/2024. The facility maintains an approved Mitigation and Infection Control Plan. Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on 6/12/2024. [LIC 809C-Continued] 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 Resident records: Resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be complete and current. Staff records: Staff files were reviewed. Criminal record clearances, Health Screening, Employee Rights records were present, and Staff are associated to this facility. Staff records appear to be complete and current.

(continued from LIC 9099) LPA's interview with the Wellness Director today at 11:14 AM revealed that R1 never missed a medication but sometime refused but then turned around and took it later. Regarding the allegation that Staff do not ensure that resident has access to a toilet while in care, it was alleged that R1 had no access to toilet. LPA's observation during physical plant tour today at 10:02 AM, revealed that R1's own apartment has its own bathroom located in own bedroom and about eight (8) to ten (10) feet away from R1's bed. LPA's interview with Executive Director today at around 11:30 AM revealed that R1 was on catheter and called on care staff to bring R1 to own bathroom to urinate without knowing that R1 had already urinated and when told about this by the staff, R1 gets agitated and yells at the staff. Regarding the allegation that Staff do not ensure that resident's showering needs are met while in care, it was alleged that R1 does not get assistance to shower. LPM Margaryan's record review on 09/14/23 and LPA's record review today between 11:00 AM to 12:00 PM revealed that R1 is scheduled to shower three (3) times a week per care plan and admission agreement and being given showers per schedule regularly unless R1 refused. LPA's interview with staff today between 12:00 PM to 1:45 PM confirmed that R1 was being given shower regularly 3x a week but sometimes refused, depends on R1's mood. Regarding the allegation that Staff do not ensure that resident makes his appointments while in care, it was alleged that coordination with appointments of R1 is not up to R1's standard. LPA's interview with Wellness director today at 11:14 AM, revealed that, all of R1's regular doctor's appointment is being coordinated by R1's Primary Care Physician (PCP) to the facility and the facility nurse coordinate with the facility driver to ensure that R1 make it to R1's appointment on time. LPA's record review today revealed that R1 did not miss any medical appointment as scheduled by R1's PCP. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time.

(continued from LIC 9099) Further review of facility medication management assessment done also on 09/22/23, confirmed that R1 was not able to manage own medication. R1 was informed about the new assessment and the charges that went with it effective 09/22/23 and again on 10/19/23. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.

R1 was sent to the hospital when they began experiencing shortness of breath and informed staff they could not breathe. During the investigation upon record review of R1s medical report R1 admitting diagnoses to the hospital on 02/25/2022 was Acute on chronic Hypercapnic and Hypoxemic Respiratory Failure, Chronic Obstructive Pulmonary Disease (COPD) Exacerbation, and Chronic Heart Failure with Preserved Ejection Fraction (HFPEF). At the time of the investigation LPA observed R1s physician report, their primary diagnoses are HRPEF and COPD. Based on interviews, observations, and record review there is not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at the time of this investigation. #2. Staff sometimes administer medications directly into the residents mouth. It is alleged that staff stated that sometimes medication is placed directly into the resident’s mouth and sometimes they take it on their own. To investigate the above allegation, LPA began interviews with staff at approximately 2:16PM on 03/11/2022. Additional staff and resident interviews were conducted on 08/22/2023 at 11:33am between 1:10pm. Interviews with eight (08) out of (08) residents revealed they get their medication from the medication room or staff deliver it to their rooms. They receive their medication in a small cup or by a spoon which is placed in their hands, or they take it by spoon. They affirm they have not had their medication placed in their mouth by staff and have not witnessed staff place medication into another residents mouth. Interviews with S2 affirm they have never placed medication into a resident’s mouth, and they are aware residents have the right to refuse medication. S2 stated that R1 has tremors, and they would assist R1 with medication by placing their hand under R1 hand to prevent shaking. At the time of the investigation, LPA observed medication being distributed to residents in a cup then into their hand and the resident places their medication in their mouth. Upon record review of R1 physician report R1 is not able to administer their own prescription medication, and Cedar Sinai discharge summary R1 has tremors of the jaw and hands. Based on interviews, observations, and record review there is not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at the time of this investigation. No health and safety hazards are noted during this visit. No deficiencies cited. Exit interview conducted and copy of report and appeal rights issued.