191603749-10-6-2021-11-AS-MVAO-C8U228-20211116160018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 10/06/2021
Date Signed: 10/06/2021 05:10:56 PM

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
12/20/2019 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20191220153134

FACILITY NAME:	MANOR, THE		FACILITY NUMBER:	191603749
ADMINISTRATOR:	STEPHANIE BROWN		FACILITY TYPE:	735
ADDRESS:	1905/2019 PICO BOULEVARD		TELEPHONE:	(310) 450-1748
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	151	CENSUS: 118	DATE:	10/06/2021
		UNANNOUNCED	TIME BEGAN:	11:26 AM
MET WITH:	Stephanie Brown		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff are intimidating clients
Staff know of and are allowing client on client abuse
Staff are allowing alcohol into facility which has resulted in client death
Staff are allowing methamphetamines to be used by clients in facility
Medications where incorrectly administered to client.
Insufficient staff on nights and weekends
Food is undercooked

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes initiated a subsequent complaint investigation for the complaint listed above. LPA arrived at facility and was greeted by staff Terri Santos, assistant administrator. LPA explained the purpose of the visit was to investigate the allegations listed above and was allowed entrance to the facility.

The investigation consisted of the following:

On 12/23/2020 LPA Cifuentes completed a walkthrough of the facility grounds and requested and received the following: copy of the current staff roster, staff schedule, client roster, client's physician’s reports, admissions agreements and emergency and ID information for client 1 to client 15. For all staff LPA requested and received copies of current training logs, mandated reporter forms, DOJ clearance, employment applications, write-ups and administrators’ certificate. On 6/3/2020, 6/4/2020 and 10/6/2021 LPA Cifuentes interviewed staff and clients. A review of the IB branch’s case report was also conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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 5

Control Number 11-AS-20191220153134

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: MANOR, THE	FACILITY NUMBER: 191603749
	VISIT DATE: 10/06/2021

NARRATIVE

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Regarding the allegation: Staff are intimidating clients
The investigation revealed the following:
Reporting party alleged that facility staff are intimidating clients. LPA Cifuentes reviewed facility house rules and resident handbook, which states that the facility strives to provide a safe and harmonious home for each resident. LPA spoke with administrator Stephanie Brown on 6/5/2020, who stated facility had an incident with a staff member yelling at a client. Client filmed incident and showed it to LPA Susan Campos. Facility was cited for personal rights and a plan of correction visit was completed on 2/11/2020, it was notied that facility had conducted their own investigation and that appropriate administrative action would be taken against staff member. On 6/4/2020 and 6/5/2020 LPA interviewed facility clients. 12 out of 14 clients interviewed stated they had not been intimidated by facility staff. On 6/5/2020 LPA Cifuentes interviewed facility staff. 4 out of 6 staff stated that they had not heard or been told of any clients being intimidated by staff members.
Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Regarding the allegation: Staff know of and are allowing client on client abuse
The investigation revealed the following:
The reporting party stated several clients were abused by their roommates and facility staff allowed the abuse to continue. Investigations Bureau Investigator Dennis Douglas reviewed records, conducted interviews with staff from this facility, facility clients, police department staff, associated medical staff and reviewed facility and Medical records/reports and found there was no evidence that abuse was occurring between residents and staff knew of the situation. When interviewed, clients denied getting into any type of altercations and felt that any verbal arguments were appropriately handled by staff when reported.
Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20191220153134

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: MANOR, THE	FACILITY NUMBER: 191603749
	VISIT DATE: 10/06/2021

NARRATIVE

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This report serves as an amendment to clarify finding. It does not supersedes the complaint investigation findings reflected on report created 10/6/2021.

Regarding the allegation: Staff are allowing alcohol into facility which has resulted in client death
The investigation revealed the following:
The reporting party alleged several clients in the facility are drinking alcohol and that Client 1 (C1) drank themselves to death. LPA Cifuentes reviewed facility handbook. Per handbook, facility is not locked, clients may come and go at their discretion and are encouraged to sign in and out when coming in or going from the facility. Per interviews with clients, staff and administrator, alcohol is not allowed on facility grounds, although there have been times when clients have brought it in. IB investigator Dennis Douglas interviewed Administrator Stephanie Brown who stated it was known by facility staff that C1 drank. Facility staff gave C1 verbal and written warnings and contacted C1’s case manager to let them know that C1 had been drinking. Due to continued alcohol use, C1 met with case manager and facility staff regarding an eviction for breaking house rules. IB investigator Dennis Douglas interviewed C1’s case manager witness 1 (W1). W1 was informed of C1’s drinking at facility on several occasions. W1 met weekly with R1 and upon receiving notice of eviction gave C1 the option of attending a rehabilitation program, which C1 declined. C1 died a few days after the meeting with staff and case manager. The coroners report for C1 states cause of death was Atherosclerotic Cardiovascular Disease and noted C1’s death was by natural causes.
Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Regarding the allegation: Staff are allowing methamphetamines to be used by clients in facility
The investigation revealed the following:
Complainant alleged that clients at facility are using methamphetamines. Investigator Dennis Douglas conducted interviews with staff from this facility, facility clients, police department staff, and associated medical staff. Police reports sent to investigations branch from the period of 7/01/2019 to 12/31/2019 do not mention any incidences of drug use or drugs being found in facility. Interviews with clients and staff state that there have been no observations of clients abusing drugs at the facility. In addition, IB investigator Douglas found through client interviews that there was no neglect or lack of care concerns identified or reported regarding the use of methamphetamines in the facility.
Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20191220153134

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: MANOR, THE	FACILITY NUMBER: 191603749
	VISIT DATE: 10/06/2021

NARRATIVE

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Regarding the allegation: Medications were incorrectly administered to client.
Complainant alleged there was an error in the medications given to client 2(C2) in November of 2019. On 12/23/2019 LPA reviewed client medication logs and found no discrepancies in the logs reviewed. When reviewing the Manor’s admissions agreement, it states that the facility will offer, ”Assistance with obtaining and taking duly prescribed medications in accordance with physician’s instructions unless prohibited by law or regulation.” The house rules and resident handbook outline that residents are encouraged to take their medications as prescribed by doctor in a timely manner and that medication is distributed by staff. On 6/4/2020 and 6/5/2020 LPA interviewed facility clients. Per C2, they did receive an incorrect pill on one occasion which was immediately rectified by staff. C1 stated it only happened one time but not in November 2019, it occurred in April of 2020. LPA Cifuentes also interviewed facility residents, 10 out of 14 clients interviewed stated they had received the correct medications in a timely manner. On 6/5/2020 LPA Cifuentes interviewed facility staff, 6 out of 6 staff stated that they had not heard, seen or been told of any clients receiving incorrect medications in the past year.
Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Regarding the allegation: Insufficient staff on nights and weekend
Complainant alleged there are insufficient staff at facility on nights and weekends and shortage of staff had led to clients not receiving their medications. On 6/4/2020 and 6/5/2020 LPA Cifuentes interviewed facility clients. 10 out of 14 clients interviewed stated they believed facility had sufficient staff on all shifts. When client were asked if they had not received a medication when they were supposed to, 10 out of 14 stated no. On 6/5/2020 LPA Cifuentes interviewed facility staff. 4 out of 6 staff stated they believed facility had sufficient staff.
Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20191220153134

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: MANOR, THE	FACILITY NUMBER: 191603749
	VISIT DATE: 10/06/2021

NARRATIVE

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Regarding the allegation: Food is undercooked
Complainant alleged that facility clients are receiving food that is still pink in the middle or frozen. The Manor’s admissions agreement states that the facility will provide, “Three nutritious meals daily and between meals nourishment or snacks. 2. Special diets if prescribed by a doctor.” LPA observed the served lunch during a facility visit on 6/23/2021 and noted that the food appeared fully cooked. On 6/4/2020 and 6/5/2020 LPA interviewed facility clients. 12 out of 14 clients interviewed stated the food they receive is good or ok with 9 out of 14 stating the food is never cold or frozen. On 6/5/2020 LPA Cifuentes interviewed facility staff. 5 out of 6 staff stated that the food at the facility is good and that it has not been cold or frozen unless it is supposed to be. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of residents records, incident report, and interviews conducted and found no evidence to support the allegations: “Staff are intimidating clients”, “Staff know of and are allowing client on client abuse”, “Staff are allowing alcohol into facility which has resulted in client death”, “Staff are allowing methamphetamines to be used by clients in facility”, “Medications where incorrectly administered to client”, “Insufficient staff on nights and weekends”, “Food is undercooked” 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 with Stephanie Brown and a copy of the report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC9099 (FAS) - (06/04)

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