191603749-10-31-2024-11-AS-UCOL-DC92KD-20241223162742

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 10/31/2024
Date Signed: 10/31/2024 09:31:12 AM

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
10/15/2024 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20241015122609

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: 119	DATE:	10/31/2024
		UNANNOUNCED	TIME BEGAN:	09:17 AM
MET WITH:	ADMINISTRATOR STEPHANIE BROWN		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff do not treat residents with respect.
Staff are physically abusive to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to The Manor Facility on 10/31/2024 and was greeted by Administrator Stephanie Brown (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following: LPA Calderon interviewed Administrator (S1), staff (S1-S3), Clients (C1-C13). LPA Calderon requested and reviewed copies of the following: Physician Report (dated 07/16/2024), Needs and Services Plan (dated 08/09/2024), incident report (dated 10/10/2024), admission agreement (dated 07/23/2024) for C1. Obtained LIC500 (dated 10/10/2024)

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

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-20241015122609

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: MANOR, THE	FACILITY NUMBER: 191603749
	VISIT DATE: 10/31/2024

NARRATIVE

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Regarding Allegation #1: Staff do not treat residents with respect.

It is being alleged that the facility staff did not treat C1 with respect. Reviewed Needs and Service plan (dated 8/9/2024) and Physician Report (dated 7/16/2024), C1 has health issues. LPA Calderon toured the facility and noted staff and clients interacting. LPA noted staff treating clients with respect. 4 out of 4 staff indicate that all staff treat all clients with respect. 4 out of 4 staff indicate that no staff yells at clients in care. C1 could not be interviewed due to being in hospital. 12 out of 13 clients indicate that no staff has treated them with disrespect. C13 is roommate with C1 and indicates that C13 has never seen staff speak to C1 or treat C1 in a disrespectful way.

Regarding Allegation #2: Staff are physically abusive to residents.

It is being alleged that facility staff are physically abusive with C1. LPA Calderon toured the facility and noted staff interacting with clients. LPA noted staff was not abusive with clients and spoke to clients in a respectful way. Reviewed Needs and Service plan (dated 8/9/2024) and Physician report (dated 7/16/2024) for C1. Records indicate that C1 has health issues. Incident report (dated 10/10/2024) indicates that C1 was taken to the hospital for health issues. Incident reports that C1 indicated issues with C13. 4 out 4 staff indicate that no staff member was abusive with C1 or any other client in care. C1 could not be interviewed due to C1 being taken to the hospital for evaluation. 12 out of 13 clients indicate that staff are never abusive with clients. C13 is roommate with C1 and indicates that C13 has never seen staff be abusive with C1.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff do not treat residents with respect”, “staff are physically abusive to residents” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Stephanie Brown (S1).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC9099 (FAS) - (06/04)

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