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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 10/24/2025
Date Signed: 10/24/2025 02:31:46 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
10/17/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20251017163700
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:
10/24/2025
UNANNOUNCEDTIME BEGAN:
08:07 AM
MET WITH:AARON KHODORKOVSKYTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff is withholding the resident's money.
Staff did not keep the facility free of insects.
INVESTIGATION FINDINGS:
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On 10/24/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Highland Manor Guest Home Facility and was greeted by Administrator Aaron Khodorkovsky (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
The investigation consisted of the following: LPA Calderon interviewed Administrator (S1), staff (S1-S5), residents (R1-R11). LPA Calderon requested and reviewed copies of the following: Physician Report (dated 10/22/2025), Needs and Service plan (dated 10/08/2025), incident report (dated 10/20/2025), Pest Control Reports (dated 08/01/2025 to 09/26/2025), Records of money received by the facility LIC405 (dated 02/01/2025 to 10/24/2025) for R1. LPA Calderon 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: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
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 3
Control Number 11-AS-20251017163700
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: 10/24/2025
NARRATIVE
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Regarding Allegation #1: Staff are withholding the residents’ money.

It is being alleged that staff did not return money to R1. During the investigation LPA Calderon toured the facility with S1 and noted no negative interactions between staff and residents. LPA Calderon noted S1 giving money to residents. LPA Calderon reviewed physician reports (dated 10/22/2025), needs and service plan (dated 10/08/2025), incident reports (dated 10/20/2025). LPA Calderon reviewed R1 records and R1 had health issues. Reviewed incident reports, R1 requested to be taken to the hospital for unknown reason and then refused to be transported to the hospital. Reviewed LIC405 (dated 02/01/2025 to 10/24/2025) indicates that starting balance was $2642.30 and ending balance was $8004.93. There are deductions and deposits in the account. R1 requested a copy of R1 account on 09/30/2025 ,10/20/2025 and 10/24/2025. S1 deny the allegation and states that R1 has access to R1 money. R1 indicates that R1 and S1 came to an agreement and R1 was given paperwork showing an account of R1 money. 10 out of 11 residents deny the allegation.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegation of “staff is withholding the resident’s money” is found to be UNSUBSTANTIATED.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20251017163700
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: 10/24/2025
NARRATIVE
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Regarding Allegation #2: Staff did not keep the facility free of insects.

It is being alleged that staff did not keep the facility free of roaches. During the investigation LPA Calderon toured the facility with S1 and noted no negative interactions between staff and residents. LPA Calderon inspected common areas to include the dining room, commercial kitchen, male and female showers, bathrooms, laundry room and rooms #4, #10, #17, #21, #38. LPA Calderon did not see any insects or roaches. LPA Calderon reviewed the pest control reports (dated 08/01/2025 to 09/26/2025). Pest control reports suggest that facility has pest control spray weekly and spray residents’ rooms on an altering schedule for roaches. S1 indicates that there are roaches found and S1 has pest control spray weekly to control the insects. 2 out of 5 staff have seen roaches in the facility. 3 out of 5 staff indicate that they have not seen roaches in the facility, but they have seen pest control treat the facility weekly to address any roaches found. R1 indicates that R1 has seen roaches in the hallway, but R1 has seen pest control spray weekly including R1 room. 3 out of 11 residents indicate that they have seen roaches in the common areas and in their rooms. 8 out of 11 residents indicate they have not seen any roaches in the facility.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegation of “staff did not keep the facility free of insects” 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 Khodokovsky S1.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3