<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603749
Report Date: 05/09/2024
Date Signed: 05/09/2024 12:19:49 PM

Document Has Been Signed on 05/09/2024 12:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:MANOR, THEFACILITY NUMBER:
191603749
ADMINISTRATOR/
DIRECTOR:		STEPHANIE BROWNFACILITY TYPE:
735
ADDRESS:1905/2019 PICO BOULEVARDTELEPHONE:
(310) 450-1748
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY: 151CENSUS: 111DATE:
05/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:09 AM
MET WITH:Stephanie Brown, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/07/2024 at 8:00 am Licensing Program Analyst (LPA) David España conducted unannounced case management-other visit in response to an incident report received on 04/25/2024 at 11:51 am via fax. LPA España met with Terry Santos, Assistant Administrator and was later joined by Stephanie Brown, Administrator. According to the incident report, on 04/25/2024 that on April 22, 2024, Client #1 called 911 at 5:00 pm stating unknown allege perpetrator broke into Client #1’s room and was raped. Based on the incident report the Santa Monica police department made report and Client #1 was sent to UCLA Santa Monica for observation. The incident report stated that Client #1 could not give description of the allege perpetrator. LPA España did not conduct interviews with staff or clients. The Investigation Bureau (IB) observed the assignment to interview Client #1 on 5/09/2024 at 9:30 am.
LPA España requested:
-A copy of the police report regarding the incident report received on 04/25/2024 at 11:51 am via fax for review.
-According to the incident report, on April 22, 2024, Corwin-4160 Reporting Officer and Cortez-4173 Reporting Officer of Santa Monica Police department wrote the said report (i.e., #24-38891).
-Administrator will request a copy and forward to licensing.
LIC809C (cont)
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 05/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
-A copy of complete file of Client #1 was requested on today’s visit.
-A copy of the informed parties of (doctor and case manager) Client #1 was also requested on today’s visit.
-A copy of the staff and client roster was also requested on today’s visit.

There were no deficiencies cited.

Exit interview was completed.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2