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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 10/06/2023
Date Signed: 02/15/2024 09:08:36 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
08/04/2023 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230804112953
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: 106DATE:
10/06/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Itzia MacielTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are using illegal drugs on facility premises due to lack of supervision.
Staff did not ensure that resident was appropriately dressed.
Residents are stealing from other residents due to lack of supervision
Staff serve cold meals to residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/07/23, Licensing Program Analyst (LPA), Perry Scott conducted a 10-day complaint investigation at the facility listed above. LPA Scott met with Itzia Maciel, Assistant Administrator, and explained the purpose of today’s visit was to investigate the allegation(s) listed above.

On 08/07/23, the investigation consisted of the following:

During today's visit LPA toured the facility and kitchen area. The kitchen was inspected and there is enough perishable and non-perishable food available, which is stored properly. While touring the kitchen area, LPA observed the kitchen staff preparing hot meals and observed it to be clean and sanitary. Additionally, LPA requested and obtained copies of the following documents: Resident and Staff Roster, Id/Emergency Information, Admission Agreement, Physicians Report, Preplacement Appraisal, Appraisal/Needs Service Plan, Client/Resident Personal Property and Valuables, MAR, and Menu Plan.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
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-20230804112953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HIGHLAND MANOR GUEST HOME
FACILITY NUMBER: 191500823
VISIT DATE: 10/06/2023
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
On 09/28/23, During today's visit from 09:50am-02:00pm, LPA conducted interviews with staff (S1-S7) and clients (C1-C10) for the complaint allegations 2-4. While IB Investigator, Dennis Seng, interviewed contacts C1 and C2 for allegation #1 on 09/05/23. The El Segundo Adult and Senior Care Regional office referred this case to the Investigations Branch, and on 08/07/23, investigator Dennis Seng was assigned to conduct the interviews for contacts C1 and C2.

The investigation revealed the following-Allegation # 1: Residents are using illegal drugs on facility premises due to lack of supervision.

It is alleged that due to lack of supervision, clients are using illegal drugs on the premises. On 08/07/23, the investigation was assigned to Investigation’s Branch (IB) Investigator, Dennis Seng. On 09/05/23, at approximately 1423 hours, IB Investigator conducted an interview with client C1 about the allegation. It was reported that C1 tested positive for drugs and witnessed another client using crack, but when ask by the investigator about the allegation, C1 denied that C1 tested positive for drugs. Additionally, C1 denied having any knowledge of C2 abusing illegal drugs in C1s presence. C1 had no additional information to provide.

On 09/05/23, at approximately 1435 hours, IB Investigator, Dennis Seng interviewed C2 about the allegation. IB investigator asked C2 about the allegation, C2 denied abusing illegal drugs at any time while at the facility and did not know why someone would file a complaint as C2 has never abused drugs while at the facility. C2 had no additional information to provide.

IB Investigator concluded that the interviews of C1 & C2 did not disclose any information that either individuals were using marijuana or crack while in the care of the facility. Furthermore, found no information to warrant a full investigation.

Based on interviews, there is insufficient evidence to support the allegation: Residents are using illegal drugs on facility premises due to lack of supervision. 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.

Allegation # 2: Staff did not ensure that resident was appropriately dressed.

It was reported that a client was walking around naked in the facility. On 09/28/23, LPA Perry Scott interviewed staff S1-S7 about the allegation. 4 of 7 staff denied the allegation that Staff did not ensure that resident was appropriately dressed. Most of the staff state that they had no complaints about clients walking around naked in the facility. LPA interviewed clients C1-C10 about the allegation. 6 of 10 clients denied the allegation. The majority of the clients state they have not seen anyone walking around naked in the facility.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20230804112953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: HIGHLAND MANOR GUEST HOME
FACILITY NUMBER: 191500823
VISIT DATE: 10/06/2023
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
Based on interviews, there is insufficient evidence to support the allegation Staff did not ensure that resident was appropriately dressed. 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.

Allegation # 3: Residents are stealing from other residents due to lack of supervision.

It was reported that clients are stealing from other clients due to lack of supervision. On 09/28/23, LPA Perry Scott interviewed staff S1-S7 about the allegation. 4 of 7 staff denied the allegation that Residents are stealing from other residents due to lack of supervision. Most of the staff report that clients have not complained of theft in the facility. However, they do advise the clients to make sure their door is locked once they leave their rooms to safeguard their valuables in the event someone wants to steal from them. LPA interviewed clients C1-C10 about the allegation. 8 of 10 clients denied the allegation. The majority of the clients state that they have not had an issue with theft in the facility.

Based on interviews, there is insufficient evidence to support the allegation Residents are stealing from other residents due to lack of supervision. 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.

Allegation # 4: Staff serve cold meals to residents.

It was reported that the facility serves cold meals to its clients. On 09/28/23, LPA Perry Scott interviewed staff S1-S7 about the allegation. 7 of 7 staff denied the allegation that Staff serve cold meals to residents. All staff stated that the facility does not serve cold meals to residents; the meals are prepared and served hot to the clients. During the tour of the kitchen, LPA observed that the kitchen staff were preparing hot meals for the clients and did not observe meals that were cold. LPA interviewed clients C1-C10 about the allegation. 9 of 10 clients denied the allegation. The majority of the clients stated that the facility does in fact serve hot meals to its clients.

Based on interviews and observations, there is insufficient evidence to support the allegation Staff serve cold meals to residents. 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 given to Itzia Maciel, Assistant Administrator.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3