191500823-5-12-2022-11-AS-EMAZ-CGS2D2-20220728171738

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500823
Report Date: 05/12/2022
Date Signed: 05/12/2022 11:23:32 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2022 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20220429084212

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:	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	08:58 AM
MET WITH:	Aaron Khodorkovsky-Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff make inappropriate comments towards resident
Staff are withholding services to resident
Staff are not treating resident's equally
Staff are engaging in inappropriate behaviors towards resident

INVESTIGATION FINDINGS:

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On 5/12/2022 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced initial complaint visit at this facility. LPA spoke with administrator Aaron Khodorkovsky via telephone prior to entering the facility to conduct risk assessment and was informed that facility has no COVID-19 cases nor do any of the clients have symptoms. LPA arrived at facility and explained the purposed of the visit is to investigate the allegations listed above.

The investigation consisted of the following: on 5/5/2022 LPA Cifuentes conducted a tour of facility grounds and reviewed facility files. LPA requested and received the following documents: Admissions agreements and physicians assessments for clients (C1-C3). LPA interviewed clients C1-C9 and staff S1-S6. On 5/12/2022 LPA Cifuentes interviewed S7.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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-20220429084212

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: HIGHLAND MANOR GUEST HOME	FACILITY NUMBER: 191500823
	VISIT DATE: 05/12/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff make inappropriate comments towards resident

It is alleged that facility staff are making inappropriate comments toward clients. LPA Cifuentes spoke with S1, who stated they have received no reports of staff or clients, calling clients names or speaking inappropriately to clients. LPA Cifuentes interviewed clients (C1-C9) and asked them if staff made inappropriate comments towards them. Of those interviewed, eight out of nine stated staff did not make inappropriate comments to them. LPA interviewed staff (S1-S7) regarding the allegation. All seven staff stated they did not make inappropriate comments towards clients. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff are withholding services to resident

It is alleged that facility staff are withholding services to clients. LPA Cifuentes spoke with S1, who stated staff will sometimes ask clients to wait a few minutes for assistance, but clients are never denied services. LPA Cifuentes interviewed clients (C1-C9) regarding the allegation. Of those interviewed eight out of nine clients stated that staff do not withhold services from them. LPA interviewed staff (S1-S7) regarding the allegation. All seven staff stated that clients are not denied services, with a few adding in that they have to clients to wait if they are assisting someone else. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff are not treating resident's equally

It is alleged that facility staff do not treat all clients equally. Per S1, all clients are treated equally, but if staff are occupied and have to tell clients to wait or clients are asked to wait in line, they may become upset. LPA Cifuentes interviewed clients (C1-C9) regarding the allegation. Of those interviewed, eight out of nine stated staff treated them equally. LPA interviewed staff (S1-S7) regarding the allegation. All seven staff stated all clients are treated equally. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Continued on 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20220429084212

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: HIGHLAND MANOR GUEST HOME	FACILITY NUMBER: 191500823
	VISIT DATE: 05/12/2022

NARRATIVE

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Allegation: Staff are engaging in inappropriate behaviors towards resident

It is alleged that staff are engaging in inappropriate behaviors towards residents. LPA Cifuentes interviewed S1, who stated there have been no reports made of staff engaging in inappropriate behavior towards residents. LPA Cifuentes interviewed clients (C1-C9) regarding the allegation. Of those interviewed, eight out of nine stated staff did not engage in inappropriate behaviors towards them. LPA interviewed staff (S1-S7) regarding the allegation. All seven staff stated they do not engage in inappropriate behaviors towards clients.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Based on information gathered, the department did not find sufficient evidence to support allegations " Staff make inappropriate comments towards resident,” “Staff are withholding services to resident,” “Staff are not treating resident's equally,” “Staff are engaging in inappropriate behaviors towards resident”

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, therefore the allegations are Unsubstantiated.

An exit interview was conducted, and a copy of this report left with Administrator Aaron Khodorkovsky.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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