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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 08/30/2021
Date Signed: 08/31/2021 08:13:56 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/24/2021 and conducted by Evaluator Ulysses Coronel
COMPLAINT CONTROL NUMBER: 11-AS-20210824161605
FACILITY NAME:HIGHLAND MANOR GUEST HOMEFACILITY NUMBER:
191500823
ADMINISTRATOR:AARON KHODORKOVSKYFACILITY TYPE:
735
ADDRESS:3570 E. IMPERIAL HWY.TELEPHONE:
(310) 631-7569
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:106CENSUS: 89DATE:
08/30/2021
UNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Aaron KhodorkhovskyTIME COMPLETED:
05:02 PM
ALLEGATION(S):
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Resident is being harassed while in care.
Staff threatened to evict resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ulysses Coronel initiated a complaint investigation for the allegation listed above. LPA met with Aaron Khodorkhovsky, the facility administrator and the purpose of the visit was explained.

The investigation consisted of the following: During today’s visit LPA and S2 conducted a tour of the facility, which includes client bedrooms, restroom, kitchen, dining room and outside smoking areas. LPA interviewed the administrator, 2 staff and 8 out of 89 clients. LPA reviewed client and facility records.

The Investigation revealed the following: Regarding the allegation: "Resident is being harassed while in care." During Todays visit the administrator and 2 caregiver staff on duty denied harrassing any residents and knowing of any residents being harrassed while in care. During todays visit 8 out of 8 clients interviewed denied that they were being harrassed by staff. C1 stated "They do allow my roommate to annoy me but the administrator does not harras me." C7 stated "Staff always speaks to me and my roommate together, I have never witnessed staff harrassing us clients." Record reviews of the client roster indicate that C1 and C7 are roommates."
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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 2
Control Number 11-AS-20210824161605
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HIGHLAND MANOR GUEST HOME
FACILITY NUMBER: 191500823
VISIT DATE: 08/30/2021
NARRATIVE
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Regarding the allegation: "Resident is being harassed while in care." 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.

Regarding the allegation: "Staff threatened to evict resident." During Todays visit the administrator and 2 caregiver staff on duty denied threatening to evict any clients, the administrator stated "I did not threatened to evict any client if they called or made a report to the licensing. I told C1 that If they do not agree to a compromise with their roommate that they are free to find placement somewhere else. I even showed C1 the complaint number posted in the lobby to C1 when they threatened to file complaints against the facility." During todays visit 7 out of 8 clients interviewed denied being threatened with evictions by any staff. C7 stated that "The administrator always speaks to me and C1 together, the administrator never ever threatened to evict C1 if they filed a complaint with the state. C1 always threatens staff with filing complaints with the state whenever they do not get what they demand." During todays visit LPA observed the complaint poster posted by the entrance lobby. Regarding the allegation: "Staff threatened to evict resident." 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. An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ulysses Coronel
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2