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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 03/12/2025
Date Signed: 03/12/2025 03:02:13 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20250307120806
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:
03/12/2025
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:ADMINISTRATOR AARON KHODORKOVSKYTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff unlawfully evicted a client while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Community Care Licensing Division (CCLD) staff conducted an unannounced visit to Highland Manor Guest Home Facility on 03/12/2025 and was greeted by Administrator Aaron Khodorkovsky (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.
The investigation consisted of the following: CCLD staff interviewed Administrator (S1), staff (S1-S3), residents (R1-R11).

CCLD staff requested and reviewed copies of the following: Physician Report (dated 01/25/2025), Needs and Service plan (dated 01/25/2025), incident reports (dated 02/18/2025, 02/24/2025 and 03/07/2025), Martin Luther King (MLK) Hospital records (dated 02/18/2025), email/text (dated 02/27/2025) for R1. CCLD staff toured the facility with S1.

The investigation revealed the following:

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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-20250307120806
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HIGHLAND MANOR GUEST HOME
FACILITY NUMBER: 191500823
VISIT DATE: 03/12/2025
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
Regarding Allegation #1: Staff unlawfully evicted a client while in care.

It is being alleged that staff unlawfully evicted R1. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (dated 01/25/2025), needs and service plan (dated 01/25/2025), incident reports (dated 02/18/2025, 02/24/2025 and 03/07/2025). CCLD staff reviewed R1 records and R1 had health issues. Reviewed incident reports, R1 missed dialysis 2 times and was taken to the hospital for treatment. On 03/07/2025 R1 moved out of the facility. Reviewed text between R1 sister and administrator dated 02/27/2025, per text R1 was accepted into new facility. Text suggests that R1 moved to live closer to R1 mother. 3 out of 3 staff denied the allegation that staff had unlawfully evicted R1, and staff indicates that R1 was never given a notice of eviction. 10 out of 11 residents indicate that staff has not given them an eviction notice. R1 could not be interviewed as R1 no longer lives in facility as of 03/07/2025.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegation of “staff unlawfully evicted a client while in care” is found to be UNSUBSTANTIATED.



No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Aaron Khodorkovsky S1.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2