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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 12/12/2024
Date Signed: 12/12/2024 10:07:57 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, THEFACILITY NUMBER:
191603749
ADMINISTRATOR:STEPHANIE BROWNFACILITY TYPE:
735
ADDRESS:1905/2019 PICO BOULEVARDTELEPHONE:
(310) 450-1748
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:151CENSUS: 119DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:ADMINISTRATOR STEPHANIE BROWNTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Resident was sexually assaulted while in care.
INVESTIGATION FINDINGS:
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On 12/13/2024 the Community Care Licensing Division (CCLD) staff conducted an unannounced visit to The Manor Facility and was greeted by Administrator Stephanie Brown (S1). The purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.
The investigation consisted of the following: CCLD staff interviewed, 4 staff (S1-S4), 3 Clients (C1-C3) and 4 witnesses (W1-W4). CCLD staff requested and reviewed copies of the following: Client records, University California Los Angeles (UCLA) hospital records, St. Joseph Center housing client notes, Santa Monica Police Department incident report. The investigation revealed the following:
Regarding Allegation: Resident was sexually assaulted while in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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 2
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: 12/12/2024
NARRATIVE
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It is being alleged that C1 was sexually assaulted by other clients while in care. On 10/04/2024 St. Joseph case management records indicate on that C1 reported to case manager that other clients attempted to sexually assault C1 at the facility. On 10/10/2024 Police records indicate that C1 refused sexual assault examination when offered. On 10/10/2024 Hospital records indicate that C1 was placed on 5150 holds after exhibiting psychotic symptoms at the facility leading to safety concerns and C1 was admitted.

Interviews revealed the following: 4 out of 4 staff interviewed denied any knowledge of the rape allegations for C1. 2 out of 3 clients interviewed denied witnessing any sexual abuse towards C1.

Based on records review and interviews, the preponderance of evidence standard has not been met; therefore, the allegations of “resident was sexually assaulted while in care” 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: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2