191500823-5-10-2023-11-AS-RORN-CT9LBF-20230629083641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 05/10/2023
Date Signed: 05/10/2023 03:50:56 PM

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
03/22/2023 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230322103640

FACILITY NAME:	HIGHLAND MANOR GUEST HOME		FACILITY NUMBER:	191500823
ADMINISTRATOR:	AARON KHODORKOVSKY		FACILITY TYPE:	735
ADDRESS:	3570 E. IMPERIAL HWY.		TELEPHONE:	(310) 631-7569
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	106	CENSUS: 105	DATE:	05/10/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Itzia Maciel, Assistant Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not ensure food served is of good quality and quantity for clients in care.
Staff do not ensure bathrooms are kept in sanitary conditions for clients in care.
Staff did not ensure client received unopened mail correspondence.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Itzia Maciel, Assistant Administrator

The investigation consisted of following: Interviews and Record reviews. On 03/28/23, LPA Soto conducted interviews with S#1 - Assistant Administrator and S#2 - S#11. The LPA toured and observed facility. Toured rooms #21, 20, & 24 and shared bathrooms, men and women shared showers, lunch meal (nacho's- chips, ground beef, cheese, sour cream, salsa, lettuce kitchen,) freezer’s, dining room, front office, business office/activity room, conference room, and eastside patio. LPA also requested copies of the following documents: Resident and Staff rosters, Partial file for R#1 & R#2; (ID/Emergency Information, Needs and Services Plan, Physician's Report, Admissions Agreement,) and Menus (February and March 2023.) On 05/10/23, LPA interviewed C#1 – C#11, obtained current Client and Staff roster’s, menus for April and May 2023, and cleaning map (House Keeper’s.)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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-20230322103640

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: 05/10/2023

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following.

Allegation 1 – Staff do not ensure food served is of good quality and quantity for clients in care. Interviews conducted with S#1 – S#11, communicated that they serve good quality food, and they serve enough. They recently hired a new cook, and she is improving the menu. The client’s like her food. The portions they serve are enough and if client’s do not get full, they are offered seconds servings. Some staff eat at the facility because they like the food and they get good size portions of food. Interviews conducted with C#1 - C#5, C#7 – C#9, C#11, communicated that the food is okay. It could be better. They could be serving food like hamburgers. The food they serve is enough and they can get seconds if they ask for them. They offer good snacks: chips, cookies, juice. LPA toured the kitchen, inspected their food storage, observed the lunch being served, and reviewed their menu’s. The facility has enough food for the facility. The food portions were enough, and their menus had a variety of food choices. The interviews, observations, and record review did not concur with the above allegation.

Allegation 2 - Staff do not ensure bathrooms are kept in sanitary conditions for clients in care. Interviews conducted with S#1 – S#11, communicated that the bathroom are always clean. S#1, S#5, S#6, S#7, S#8, & S#10, the bathrooms sometimes are unclean because of the clients themselves. Some clients have a hard time keeping their bathroom clean all day. They may have accidents during the day. The house keeper’s clean all the bathroom and showers once a day, 7 days a week. If the bathrooms have already been cleaned and the clients request the bathrooms to be cleaned again, the house keeper’s go and clean them again. The staff has no problem cleaning the bathrooms again. Interviews conducted with C#2 - C#11, communicated that the are always clean. The house keeper’s clean their bathrooms once a day. Sometimes they get dirty because some clients don’t know how to keep them clean, but the house keeper’s do a good job keeping the bathrooms clean daily. The interviews conducted did not concur with the above allegation.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230322103640

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: 05/10/2023

NARRATIVE

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Allegation 3 - Staff did not ensure client received unopened mail correspondence. Interviews conducted with S#1 – S#11, communicated that they Interviews conducted with S#1 – S#11, communicated that the receptionist sorts and delivers the mail. S#2 communicated that S#2 receives the mail from the business manager and then S#2 sorts the mail by room number and S#2 personally delivers mail to each client. If the client is not at their room, S#2 hold mail until next day to deliver it with next day’s mail. S#2 never opens any clients mail for any reason. Interviews conducted with C#2 - C#11, communicated that they all receive mail at the facility, and it’s never been delivered opened. The interviews conducted did not concur with the above allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated

An exit interview was conducted with Itzia Maciel, Assistant Administrator, and a hard copy of report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC9099 (FAS) - (06/04)

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