191500823-5-14-2025-11-AS-RORN-DH5TU3-20250529150141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 05/14/2025
Date Signed: 05/14/2025 03:21:44 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
11/19/2024 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20241119155635

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: 106	DATE:	05/14/2025
		UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Assistant Administrator Itzia Maciel		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not prevent resident(s) from sexually abusing other resident in care.
Staff did not prevent resident(s) from verbally abusing other resident in care.

INVESTIGATION FINDINGS:

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On 5/14/25 at 9am the Department conducted a subsequent complaint investigation visit regarding the allegation(s) above. The Department met with (S1) Assistant Administrator Itzia Maciel as the purpose of the visit was explained.

The investigation consisted of the following: On 11/21/24 The Department and (S1) conducted a tour of the facility which included checking random client bedrooms. On 11/21/24 The Department obtained copies of the Client and Staff Rosters as well as copies of following documents for client #1(C1); Emergency ID Information, Admission Agreement dated: 05/29/24, Physicians Report dated: 10/07/24, Preplacement Appraisal dated: 05/31/24, Appraisal/Needs Service Plan dated: 10/30/24, Client MAR, and incident reports dated: 7/3/24, 7/29/24, 8/1/24, 11/11/24, and 11/20/24. On 12/23/24 The Department conducted intertivew with C1. On 5/14/25 from 9:30am-10:45am The Department conducted interviews with client #2-11 (C2-C11), and from 10:50am-11:31am interviews ere conducted with staff #1-6 (S1-S6).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

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-20241119155635

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: 05/14/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Staff did not prevent client(s) from sexually abusing other client in care.
It is being alleged that client in care has been sexually abused by other clients.
On 12/23/24 The Department conducted interview with C1 regarding the allegation above, during the interview C1 could not provide information regarding the allegation above. On 05/14/25 from 9:30 am-10:45am The Department conducted interviews with C2-C11 regarding the allegation above, 10 of 10 clients interviewed denied the allegation above and reported feeling safe living at Highland Manor Guest Home. On 05/14/25 from 11:00 am-11:50 am interviews were conducted with S1-S6 regarding the allegation above, 6 of 6 staff interviewed denied the allegation above. On 05/14/25 The Department conducted a review of C1's file, per incident report dated 11/20/24 C1 was placed on a psychiatric hold due to hallucinations and feeling anxious.

Allegation: Staff did not prevent client(s) from verbally abusing other client in care.
It is being alleged that It is being alleged that client in care has been verbally abused by other clients.
On 12/23/24 The Department conducted interview with C1 regarding the allegation above, during the interview C1 could not provide any information regarding the allegation above.
On 05/14/25 from 9:30 am-10:45am The Department conducted interviews with C2-C11 regarding the allegation above, 8 of 10 clients interviewed denied the allegation above, 2 of 10 clients interviewed report getting into arguments with peers in the past. On 05/14/25 from 11:00 am-11:50 am interviews were conducted with S1-S6 regarding the allegation above, 4 of 6 staff interviewed denied the allegation above, 2 of 6 staff interviewed reported clients have had verbal arguments, but staff intervene and redirect. On 05/14/25 The Department conducted a review of C1's file, per incident report dated 11/11/24 C1 was placed on alert charting for change in condition due to inappropriate comments.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

LIC9099 (FAS) - (06/04)

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