191500823-5-7-2026-11-AS-SCIS-DUQTK6-20260604144725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 05/07/2026
Date Signed: 05/07/2026 04:46:15 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
04/27/2026 and conducted by Evaluator Troy Watson

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260427135007

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: 105	DATE:	05/07/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	ADMINISTRATOR - AARON KHODORKOVSKY		TIME COMPLETED:	04:44 PM

ALLEGATION(S):

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The facility is not providing client with P&I.

INVESTIGATION FINDINGS:

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On 05/07/2026 at approximately 08:45 AM, Licensing Program Analyst (LPA) Troy Watson conducted an initial complaint visit regarding the above allegation. LPA met with the Administrator, Aaron Khodorkovsky, and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of the following

On 05/07/2026 between 08:45 AM – 02:15 PM, the Department requested and obtained the following records: Personnel Report (12/10/25),Resident Roster Record of Clients/Residents Safeguarded Cash Resources for C1,C2,C3,C4,C5 (01/01/26 – 05/04/26), Medical Assessment for Residential Care Facilities for the Elderly (10/13/25), Initial Evaluation Consultation for C1(04/20/26), St. Francis Medical Center Admission/Registration for C1 (05/06/26–05/07/26), Unusual Incident Reports for C1 (01/15/26, 03/16/26, 03/25/26), Resident Statement Landscape (10/06/23).
COTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

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-20260427135007

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: 05/07/2026

NARRATIVE

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On 05/07/2026 between 09:45 AM – 12:30 PM, the Department conducted interviews with Staff #1–#5 (S1–S5) and Clients #2–#10 (C2–C10). An attempt to interview C1 was made, but C1 was not at the facility at the time of the interview.

Investigation revealed the following:

Allegation: The facility is not providing C1 with P&I.

It is alleged that the facility is not providing C1 with P&I funds, as C1 reported the facility is supposed to give a $400 monthly allowance that has not been provided. On 05/07/2026, between 08:45 AM – 02:15 PM the department conducted an interview with the Administrator (A1). The Department asked A1 how the facility manages and distributes monthly Personal and Incidental (P&I) funds and how each disbursement is documented. A1 stated that funds are typically disbursed on the 1st of each month, and some clients receive funds on Mondays or upon request during the week. A1 explained that all disbursements are recorded on a P&I sheet, which documents the amount received from Social Security, and includes the client’s signature acknowledging receipt and the amount of money dispersed.
The Department also asked A1 whether any circumstances would delay or prevent a client from receiving their full monthly allowance. A1 said that delays in receiving money only occur if the client is hospitalized, placed in a skilled nursing facility, or receives a reduced Social Security Insurance (SSI) payment. A1 also said that a reduced payment from SSI may result from a change in the client’s living situation or SSI overpayment, and Social Security provides written notice when this occurs.
The Department also asked A1 about the facility’s process for handling missing P&I when a client reports missing or withheld funds. A1 stated that the facility conducts an internal review of SSI payments and the signed P&I ledgers to determine whether there is a missing funds issue. Clients sign for all disbursements, and this documentation is used during the investigation. If the issue involves an SSI adjustment or overpayment, the client’s check is accompanied by the corresponding Social Security letter explaining the change.

CONTINUED ON LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260427135007

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: 05/07/2026

NARRATIVE

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On 05/07/2026 between 08:45 AM – 02:15 PM, the department observed clients waiting for P&I cash disbursements the department did not observe any negative interactions between staff and clients.
On 05/07/2026 between 08:45 AM – 02:15 PM, the department conducted interviews with Staff #1–#5 (S1–S5). Out of those interviewed, 5 out of 5 staff denied the allegation. On 05/07/2026, the Department conducted interviews with Clients #2–#10 (C2–C10). Out of those interviewed, 9 out of 9 clients denied the allegation.

On 05/07/2026, between 08:45 AM. and 02:15 PM., the Department requested and reviewed Client 1’s (C1) document titled “Resident Statement Landscape” dated 10/06/23. This document showed Social Security Administration (SSA) payments received for rent and personal and incidental (P&I) funds. The Department also reviewed the “Record of Clients/Residents Safeguarded Cash Resources” dated 01/01/26 – 05/04/26 for C1. A review of these documents determined that the alleged missing amount reported for C1 was inaccurate and that C1’s actual monthly allowance was significantly lower and consistent with the P&I disbursements recorded on the signed P&I log. Both documents showed that C1 consistently received their monthly allowance, with each disbursement documented arid signed by the client.Based on the records reviewed, the Department found no evidence indicating that P&I funds were withheld or not provided to the client.

Based on the information gathered and records reviewed, there is insufficient evidence to support the allegation, “The facility is not providing clients with P&I.” Although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated.
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SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

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