191500823-6-18-2026-11-AS-UCOL-DVDS5K-20260625133426

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 06/18/2026
Date Signed: 06/18/2026 04:58:01 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, 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
12/17/2025 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251217130559

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:	06/18/2026
		UNANNOUNCED	TIME BEGAN:	04:19 PM
MET WITH:	Itzia Maziel/Administrator Assistant		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not prevent residents from using illegal drugs inside of facility.
Staff do not prevent residents from smoking inside of facility.
Staff did not ensure that resident takes medication as prescribed.
Staff do not provide a safe environment for residents in care.

INVESTIGATION FINDINGS:

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On 6/18/2026, Licensing Program Analyst-LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met Itzia Maziel/Administrator Assistant explained the purpose of this visit.

Investigation Consisted of: the department conducted the following interviews: Administrator interview (A#1), Facility staff interviews(S#1-S#10), Clients Interviews (C#1-C#4). The department gathered the following documents: copy of Investigations Branch (IB) report dated: 4/14/2026.

Evaluation Report continues LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

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 12

Control Number 11-AS-20251217130559

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: 06/18/2026

NARRATIVE

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Investigation Revealed the Following:

Staff do not prevent residents from using illegal drugs inside of facility

The details of the complaint alleged that facility staff are not preventing residents from using illegal drugs inside the facility.

On 12/29/2025, during the investigation conducted by the Investigations Branch (IB), they conducted interviews, and reviewed facility records. Evidence showed that multiple clients (C#1-C#4) used illegal substances while residing at the facility. Facility staff and the administrator were aware of ongoing drug use, and staff had confiscated pipes and observed residents under the influence, yet the facility did not enforce its own drug-use policies, did not issue required written warnings, and did not conduct room searches as outlined in the Resident House Rules. The facility administrator (A#1) acknowledged knowing about drug use but did not take corrective action consistently with facility policy.

Staff do not prevent residents from smoking inside of facility.

The details of the complaint alleged that facility staff are allowing residents to smoke inside the facility.

On 12/29/2025, during the investigation conducted by the Investigations Branch (IB), the investigation determined that residents smoked inside their rooms without effective intervention by facility staff. Multiple caregivers (S#1-S#6) reported observing residents smoking substances, including marijuana and crack cocaine, inside their rooms. Housekeepers (S#7-S#10) also reported that clients frequently smoked in their rooms and that drug use was more prevalent in certain hallways. Although the facility’s House Rules prohibit smoking and allow staff to search for belongings, staff reported that room searches were not conducted and that enforcement was inconsistent.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 12

Control Number 11-AS-20251217130559

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: 06/18/2026

NARRATIVE

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Staff did not ensure that resident takes medication as prescribed

The details of the complaint alleged that facility staff are not ensuring residents are taking their medications as prescribed.

On 12/29/2025, during the investigation conducted by the Investigations Branch (IB), the investigation revealed that staff did not consistently ensure residents took medications as prescribed. During an onsite observation, a resident was found in possession of a pill cup containing their medications, indicating that medications were not administered or monitored according to regulatory requirements. Staff interviews(S#1-S#6) confirmed inconsistent monitoring practices, and the Investigations Branch (IB) reported identified this as supporting evidence of neglect.

Staff do not provide a safe environment for residents in care

The details of the complaint alleged that facility staff are not providing a safe environment for residents in care due to the ongoing drug use inside the facility.

On 12/29/2025, during the investigation conducted by the Investigations Branch (IB), the investigation revealed that the facility staff failed to provide a safe environment due to ongoing drug use, repeated resident falls, lack of supervision, and failure to enforce safety policies. Residents experienced multiple falls resulting in hospitalizations, and drug-related behaviors, including aggression, altered mental status, and unsafe smoking were not adequately addressed. Staff (S#1-S#10) reported insufficient rounding, lack of security personnel, and inconsistent enforcement of safety rules. The administrator (A#1) acknowledged that drug use was ongoing, and that enforcement of house rules was not occurring.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 12

Control Number 11-AS-20251217130559

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: 06/18/2026

NARRATIVE

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Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D).

An exit interview was conducted, and a copy of the Complaint Report was given to Itzia Maziel/Administrator Assistant.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 12

Control Number 11-AS-20251217130559

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/18/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/06/2026 Section Cited CCR 80072	1 2 3 4 5 6 7	80072 Personal Rights= 80072(a)(2) CCR Type B (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Licensee will always adhere to Title 22. As a plan of correction, the facility will remind the clients that smoking is not allowed inside the facility and the use of illegal drugs. Proof of correction will be sent to LPA Iniguez via email before POC due date.
	8 9 10 11 12 13 14	Based on observation and interviews the licensee failed to ensure that residents were accorded safe and healthful accommodations, clients (C#8,C#13,C#14 and C#15) were allowed to use illegal drugs and smoke tobacco inside the facility without effective intervention, this poses a potential health and safety risk to all clients in care.	8 9 10 11 12 13 14
Type B 07/06/2026 Section Cited CCR 80075	1 2 3 4 5 6 7	80075 Health Related Services=80075(b) Type B (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Licensee will always adhere to Title 22. As a plan of correction, the facility will conduct an all staff in-service regarding making sure clients takes their medications as prescribe. Proof of correction will be sent to LPA Iniguez via email.
	8 9 10 11 12 13 14	Based on observation and interviews, staff failed to ensure that clients were assisted with the self administration of their medications. On 1/22/2026, staff did not ensure that client (C#16) took their medications as prescribed, as the client was found in possession of a pill cup containing their medications and was not observed taking them by facility staff. This poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14

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

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 12

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
12/17/2025 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251217130559

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:	06/18/2026
		UNANNOUNCED	TIME BEGAN:	04:19 PM
MET WITH:	Itzia Maziel/Administrator Assistant		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not provide quality food to clients.
Staff do not assist residents with ambulating.
Staff do not assist residents with obtaining medical care.
Licensee does not ensure that a skilled professional staff provides medical care to resident.
Staff are not addressing pests inside at facility.
Staff do not maintain facility in good repair.
Facility is malodorous.
Staff do not provide residents with laundry service.

INVESTIGATION FINDINGS:

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On 6/18/2026, Licensing Program Analyst-LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met Itzia Maziel/Assistant Administrator. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: the department conducted the following interviews: Administrator interview (A#1), Facility staff interviews(S#1-S#11), Clients Interviews (C#1-C#11). The department gathered the following documents: copy of facility menus for the month of November 2025, a health and safety check of the facility, copy of (C#1) service plan dated:11/4/25, copies of staff training records related to client care and fair treatment, copy of (S#12) Vocational Nurse licensed with an expiration date of 2/28/2027, copy of facility’s personnel report or LIC 500 dated: 12/10/2025, copies of pest control service reports from Dever Pest Control covering multiple service dates in October and November 2025, copy of client’s admission agreements with various dates.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 6 of 12

Control Number 11-AS-20251217130559

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: 06/18/2026

NARRATIVE

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Investigation Revealed the Following:

Staff do not provide quality food to clients.

The details of the complaint alleged that facility is serving frozen foods, waffles and eggs every day to clients in care.

On June 3, 2026, during the records review, the Department observed copies of the facility’s menu for the month of November 2025. The Department noted that the facility offers a variety of food items, and the total daily diet appeared to be of the quality and in the quantity necessary to meet the needs of residents. The menu reflected meals consistent with the Recommended Dietary Allowances established by the Food and Nutrition Board of the National Research Council. All food items were observed to be selected, stored, prepared, and served in a safe and healthy manner.

On April 9, 2026, during a health and safety check of the facility, the Department observed that the kitchen was clean, sanitary, and organized. Food items observed were well-prepared, properly stored, and not expired. The facility maintained a sufficient supply of perishable and non-perishable food, and documentation reflected that weekly food deliveries were occurring as scheduled.

On April 9, 2026, during the interviews with clients in care (C#1-C#11), (10) out of (11) stated that they agree the facility is providing a variety of quality food to them.

On April 9, 2026, during the interviews with facility staff (S#1-S#11), (7) out of (4) stated that they think the facility is providing a variety of quality food to clients in care.

Staff do not assist residents with ambulating.

The details of the complaint alleged that facility staff is not assisting (C#9) ambulating.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 12

Control Number 11-AS-20251217130559

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: 06/18/2026

NARRATIVE

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On June 3, 2026, during the records review, the Department observed a copy of (C#9)’s service plan dated November 4, 2025. Under the transfer section, the plan documented that (C#9) requires full assistance with transferring, specifically a two-person assist. Under the mobility section, the service plan indicated that (C#9) has standby assistance with a walker, uses an electric wheelchair, and utilizes half-bed rails for positioning. The plan further documented the use of a reaching device and noted that (C#9) requires two-person assistance for certain mobility tasks. The service plan stated that the care team would support (C#9) with safe ambulation, mobility, and repositioning.

On April 9, 2026, during the interviews with clients in care (C#1-C#11), (10) out of (11) stated that facility staff assist them and the other residents in care.

On April 9, 2026, during the interviews with facility staff (S#1-S#11), (8) out of (11) staff stated that residents are assisted when needed, including assistance with transfers, ambulation, and general care.

Staff do not assist residents with obtaining medical care.

The details of the complaint alleged that facility staff are not assisting clients with their medical needs.

On April 9, 2026, during the records review process, the Department reviewed various staff training records related to client care and fair treatment. The records show that staff received training in areas related to resident supervision, responding to care needs, and procedures for reporting changes in conditions. Training documents also included topics such as infection control, resident rights, and protocols for coordinating medical appointments and outside medical services.

On April 9, 2026, during the interviews with clients in care (C#1-C#11), (9) out of (11) stated that staff assist them with obtaining medical care or respond to their medical needs when assistance is requested.

On April 9, 2026, during the interviews with facility staff (S#1-S#11), (7) out of (11) staff stated that residents are assisted with obtaining medical care, including wound care, diabetic support, and treatment for lice, or reported observing that medical care is provided by designated staff.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 8 of 12

Control Number 11-AS-20251217130559

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: 06/18/2026

NARRATIVE

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Licensee does not ensure that a skilled professional staff provides medical care to resident

The details of the complaint alleged that facility does not have skilled professional staff to provide medical care to the clients.

On June 4, 2026, during the records review, the Department observed a copy of (S#12)’s Vocational Nurse license, which reflects a current license with an expiration date of February 28, 2027. In addition, the Department reviewed a copy of the facility’s Personnel Report (LIC 500) dated December 10, 2025, which lists (S#12) as the facility’s Licensed Vocational Nurse with an employment start date of February 2020. Moreover, the Department reviewed various staff training records related to client care and fair treatment. The records show that staff received training in areas related to resident supervision, responding to care needs, and procedures for reporting changes in conditions. Training documents also included topics such as infection control, resident rights, and protocols for coordinating medical appointments and outside medical services.

Staff are not addressing pests inside at facility

The details of the complaint alleged that administration is not addressing the pests inside the facility.

On June 3, 2026, during the records review, the Department observed copies of pest control service reports from Dever Pest Control covering multiple service dates in October and November 2025. The records reflect that the facility receives weekly pest control services and periodic rodent rebaiting services. For example, one report dated October 17, 2025, documents that the technician “treated the building exterior and the following rooms, for roaches, with a liquid residual chemical: Rooms #2, 3, 5, 6, 38, 39, 40, 41, 42, 43”. Another report dated October 24, 2025, shows treatment of additional rooms for roaches, and a separate report from the same date documents the rebaiting of 16 rodent bait boxes, with the technician noting, “Cleaned and re-baited rodent stations as needed.”

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 9 of 12

Control Number 11-AS-20251217130559

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: 06/18/2026

NARRATIVE

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Subsequent service reports dated October 31, 2025, November 7, 2025, November 14, 2025, November 21, 2025, and November 28, 2025, show continued weekly pest control treatments, including exterior perimeter spraying and room-specific roach treatments, as well as additional rodent rebaiting services. The Department noted that the facility maintains ongoing contracted pest control services addressing both roach activity and rodent management, with documentation showing regular technician visits, identified treatment areas, and materials used.

On April 9, 2026, during the interviews with clients in care (C#1-C#11), (5) out of (11) stated that they reported witnessing pests inside the facility, while (6) out of (11) state that they did not have pests’ issues.

On April 9, 2026, during the interviews with facility staff (S#1-S#11), (6) out of (11) staff stated that they observed pests inside the facility while (5) out of (11) stated that they had not observed pest issues or reported only minimal occurrences.

Staff do not maintain facility in good repair

The details of the complaint alleged that the facility is in disrepair.

On April 9, 2026, during a health and safety check of the facility, the Department observed no signs of facility being in disrepair, there were no indications that the structure, fixtures, or common areas were damaged or unsafe.

On April 9, 2026, during the interviews with clients in care (C#1-C#11), (8) out of (11) stated that they observed conditions indicating the facility was not maintained in good repair, while (3) out of (11) stated that they did not have concerns regarding the facility’s condition.

On April 9, 2026, during the interviews with facility staff (S#1-S#11), (11) out of (11) staff stated that they have not observed issues related to the facility being in disrepair.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 10 of 12

Control Number 11-AS-20251217130559

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: 06/18/2026

NARRATIVE

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Facility is malodorous

The details of the complaint alleged that the facility is malodorous.

On April 9, 2026, during a health and safety check of the facility, the Department noticed that no strong or pervasive odors were present at the time of the visit.

On April 9, 2026, during the interviews with clients in care (C#1–C#11), (7) out of (11) clients stated that they did not notice odors or malodorous conditions inside the facility, while (4) out of (11) clients stated they noticed odor concerns.

On April 9, 2026, during the interviews with facility staff (S#1-S#11), (11) out of (11) staff stated that they had not observed any strong or unusual odors inside the facility.

Staff do not provide residents with laundry service

The details of the complaint alleged that the facility does not provide laundry services to the clients in care.

On June 5, 2026, during the records review, the Department observed a copy of clients’ admission agreements with various dates. The Department noted that the admission agreements list “personal laundry service” as a service included in the monthly rate.

On April 9, 2026, during the interviews with clients in care (C#1-C#11), (2) out of (11) clients stated that staff provide laundry service, (0) out of (11) clients stated that staff do not provide laundry service, and (9) out of (11) clients did not express concerns regarding laundry assistance.

On April 9, 2026, during the interviews with facility staff (S#1-S#11), (11) out of (11) staff who addressed the topic stated that laundry service is provided to clients.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 11 of 12

Control Number 11-AS-20251217130559

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: 06/18/2026

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During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Itzia Maziel/Assistant Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026

LIC9099 (FAS) - (06/04)

Page: 12 of 12