191603749-11-10-2021-11-AS-MVAO-C9JRG4-20211209120007

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 11/10/2021
Date Signed: 11/10/2021 04:02:57 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
07/19/2021 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20210719160057

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: 117	DATE:	11/10/2021
		UNANNOUNCED	TIME BEGAN:	10:51 AM
MET WITH:	Stephanie Brown-Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility is not taking necessary precautions to prevent the spread of covid-19
Staff altered resident's mail.
Kitchen staff are not properly trained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at above facility. LPA arrived at the facility and was greeted by receptionist. LPA explained purpose of visit was to deliver findings for the allegations listed above and was allowed entry to the facility to meet with Administrator Stephanie Brown.

The investigation consisted of the following: On 7/27/2021 LPA conducted initial 10 day visit, met with Administrator Stephanie Brown and completed a walkthrough of facility. On 10/6/2021 LPA interviewed client 1 – client 8 (C1-C8), Staff 1-Staff 5 (S1-S5) and reviewed and requested copies of register of facility residents, staff schedule and other documents in association with the allegations.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

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-20210719160057

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: 11/10/2021

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Facility is not taking necessary precautions to prevent the spread of covid-19.
It is alleged that facility staff refused to give client a mask when it was requested. LPA spoke to Administrator Stephanie Brown regarding allegation. Per Ms. Brown, both staff and clients clean high touch areas twice a day. Facility conducts weekly testing on staff and residents and they reinforce masks and social distancing. During visits on 10/6/2021 and 11/10/2021 LPA Cifuentes had to fill put a sign in sheet in facility office, which included having temperature taken by facility staff. LPA also observed staff taking temperature of clients while giving out medications and ask client to wear they mask and offer one if they needed. LPA spoke with clients C1-C8 regarding allegation. When asked if they believed facility was taking necessary precautions against covid-19, seven out of eight clients answered yes. They added that testing was available weekly. When asked if they had ever been denied a mask by staff, six out of eight staff stated that facility staff had not denied them a mask. LPA Cifuentes interviewed staff 1-staff 5 regarding allegations. When asked if they believed facility was taking necessary precautions against covid-19, five out of five answered yes. When asked if they had ever refused a client a face mask, all five answered no. Based on information gathered and service records reviewed, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff altered resident's mail.
It is alleged that staff altered residents mail by stapling letters together. LPA Cifuentes spoke with Administrator Stephanie Brown who stated mail is brought in a tub by post office. It is sorted alphabetically by facility staff and stored in office. When clients come to the office and ask for their mail it is given to them by staff. Staff do not open residents mail. LPA observed mail area. Letter are placed into an organizer in alphabetical order. None of the mail observed was open or stapled together. LPA did observe a few envelopes wrapped in a rubber band. LPA asked facility residents if their mail had ever been opened. Of the eight questioned, eight stated their mail had not been opened by facility staff. LPA Cifuentes spoke with facility staff, of the five questioned, four stated that clients mail was not opened. The fifth staff did not work with the mail. 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: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210719160057

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: 11/10/2021

NARRATIVE

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Allegation: Kitchen staff are not properly trained
Complainant alleged that kitchen staff do not have food handlers’ certifications. LPA Cifuentes reviewed facility records. For both of the kitchen staff, S6 and S7, current food handler certificates were found. LPA spoke with administrator who stated kitchen staff all have food handlers’ certificates. LPA spoke with clients regarding food and half thought the food was prepared well while the other half either did not eat it or did not like it. LPA interviewed staff regarding kitchen staff training. Four of those questioned did not know anything about staff training and two stated that they received training in the kitchen or food handlers certificate. 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: “Facility is not taking necessary precautions to prevent the spread of covid-19,” “Staff altered resident's mail.”, “Kitchen staff are not properly trained”, 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.

Exit interview conducted, and a copy of the report was given to Stephanie Brown, Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

LIC9099 (FAS) - (06/04)

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