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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 05/10/2022
Date Signed: 05/10/2022 11:18:07 AM

Substantiated


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
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2020 and conducted by Evaluator Troy Agard
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20201207132403
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: 115DATE:
05/10/2022
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Stephanie BrownTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Client uses illegal drug while in care
Client's behavior poses as a risk to other clients while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation to deliver findings. LPA Agard met with Administrator, Stephanie Brown; LPA Agard explained the purpose of this visit is to deliver the findings for the above complaint allegations.

On 12/08/2020, LPA Agard conducted a FaceTime tour of the facility grounds for the main building and Annex. Due to the situation surrounded Coronavirus (Covid 19), and to implement mitigation measures, the initial 10-day visit was conducted virtually. LPA Agard requested the following documents be sent on or before December 9th, 2020: 1) A copy of the staff roster, 2) a copy of the client roster (matching their room numbers), 3) Incident reports from the past 90 days. 4) The needs and service plans for clients in the Annex building. 5) Emergency contacts for Annex clients.

On 05/10/2022, LPA Agard conducted a visit to the facility, to deliver findings in person
Continue on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
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 4
Control Number 11-AS-20201207132403
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
MONTEREY PARK, CA 91754
FACILITY NAME: MANOR, THE
FACILITY NUMBER: 191603749
VISIT DATE: 05/10/2022
NARRATIVE
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Regarding the allegation: Client uses illegal drugs while in care. It’s being alleged that a client or clients are using illicit drugs while in the facility.

The investigation revealed the following: During interviews with clients, 8 of 13 that were interviewed have either confirmed being aware of or have heard of potential illicit drug use in the facility. C1 states, observing drugs and other items associated in preparing them being confiscated from client’s room. C1 also provided the names of potential dealers and users. C8 has admitted to using and supplying at the facility in the past. C10 admits to using in the past and having clients inquire if they are still selling and where illicit drugs could be purchased. C11-13 states they have witnessed transactions of drug sales between clients and/or is aware of client using illicit drugs, specifically methamphetamine.

During interviews with staff, 6 of the 11 interviewees have either confirmed being aware of or have heard of potential illicit drug use in the facility. S1 states a client has received a written warning for selling drugs in exchange for sexual interactions. S3 confirmed that items used in the preparation of drugs have been observed being confiscated from clients’ room. S5 states smelling burnt foil odors coming from the rooms of clients. S7 states knowing names of clients using within the facility.

Regarding the allegation: Client's behavior poses as a risk to other clients while in care. It’s being alleged that a client is causing disruption in the facility, upsetting their peers and making them uncomfortable.

The investigation revealed the following: During interviews with clients, 8 of the 12 interviewed state they are aware of a clients’ behavior that is aggressive and poses a potential danger to them and or their peers. C1 states client C14 has been aggressive with him on two occasions. C2-3 state being aware of a client or clients that are aggressive toward their peers. C4, 5, 11, and 12, all identify the same individual client that is aggressive and posed a potential risk to clients in care. C14 was unable to participate in a interview.

During interviews with staff, 9 of the 11 interviewed agreed that C14’s behavior is either aggressive or poses a potential danger to staff and/or clients in care. S1 states C14 can me incoherent and aggressive. S2-5, 9 and 11 notes C14 would lash out and have outburst towards staff or clients. S2 states C14 would make verbal threats. S3, 9, and 11 all state C14 tends to have the most challenges during the weekend.

Cont. 9099C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20201207132403
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
MONTEREY PARK, CA 91754
FACILITY NAME: MANOR, THE
FACILITY NUMBER: 191603749
VISIT DATE: 05/10/2022
NARRATIVE
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During investigation, LPA reviewed photographic evidence of drug paraphernalia confiscated from client’s room, a warning given to C8 for selling illicit drugs within the facility and the admission of the allegation #1 by S1 and C8.

Based on interviews and record review, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (1) are being cited on the attached LIC 9099D.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20201207132403
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
MONTEREY PARK, CA 91754

FACILITY NAME: MANOR, THE
FACILITY NUMBER: 191603749
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2022
Section Cited
CCR
80072(a)(2)(3)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe...to meet his/her needs. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other
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Facility will develop a protocol to address the use of illicit drugs in the facility and steps to mitigate. This protocol will be reviewed with all facility staff. Protocol and training will be shared with licensing by POC due date.
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actions of a punitive nature, ...interference with the daily living functions…This requirement was not met as evidence by: a record review and interviews which shows that facility has a history of clients using illicit drugs and a client that is displaying disruptive behavior. Which poses a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4