191500823-7-10-2024-11-AS-UCOL-D79VP7-20240717163615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 07/10/2024
Date Signed: 07/10/2024 03:25:07 PM

Substantiated

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
03/01/2024 and conducted by Evaluator Socorro Leandro

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240301152839

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:	07/10/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator Assistant - Itzia Maciel		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not prevent residents from smoking illegal drugs inside of the facility

INVESTIGATION FINDINGS:

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On 07/10/2024, Licensing Program Analyst (LPA), Leandro conducted a subsequent complaint investigation at the above facility to deliver findings on the allegation listed above. The LPA met with the Administrator Assistant, Itzia Maciel and explained the purpose of the visit.

The investigation consisted of the following: On 03/04/2024 LPA conducted a tour of the facility, requested facility and client records, and interviewed 4 staff and 1 client. On 03/12/2024 the Departments Investigation Bureau (IB) resumed the investigation.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

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-20240301152839

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: 07/10/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation “Staff do not prevent residents from smoking illegal drugs inside of the facility,” it is being alleged that clients bring drugs into the facility and smoke drugs inside their rooms. Record reviews indicate the following: The facility Admission Agreement says residents may “not bring any non-prescribed drugs or alcohol…onto the grounds at any time. Anyone possessing or under the influence of illegal drugs or narcotics will be removed from the Home, and the matter will be brought to the attention of local law enforcement officials.” The facility Resident House Rules state in part that “No drugs or alcohol shall be allowed in the facility. Residents who violate the house rule on narcotic possession, shall be given two written warnings, will attend a case conference that will include Facility Psychologist and Administrator. If the resident continues to violate this rule after the case conference, a 30-day eviction notice shall be served.” Interviews revealed the following: Client 1 (C1) and Client 2 (C2) admitted that they have smoked illegal drugs inside the facility. Caregivers have confiscated “pipes” (used for illegal drugs) from clients in care on numerous occasions. Interviews also revealed that facility staff and witnesses are aware of ongoing drug use for clients C1, C2, C3 and C4. Regarding the allegation above the preponderance of the evidence standard has been met therefore the allegation is substantiated.

Deficiencies cited based on record review and observations in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted, and a copy of this report was left with the Administrator Assistant along with their appeal rights.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20240301152839

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/30/2024 Section Cited CCR 80072(a)(2)	1 2 3 4 5 6 7	Personal Rights (a) Except for children’s…each client shall have...the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will develop a plan to address the use of illegal drugs in the facility. This plan will be reviewed with all facility staff. Protocol and training will be shared with licensing by POC due date. Email: Socorro.Leandro@dss.ca.gov & Ulysses.Coronel@dss.ca.gov
	8 9 10 11 12 13 14	Based on interviews conducted the Licensee failed to ensure that clients are accorded a safe, healthful and comfortable accommodations, the facility did not enforce its policies on drug use which poses a potential health & safety risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

LIC9099 (FAS) - (06/04)

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