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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603749
Report Date: 07/03/2024
Date Signed: 07/03/2024 12:05:49 PM

Document Has Been Signed on 07/03/2024 12:05 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: 105DATE:
07/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:05 AM
MET WITH:Stephanie Brown, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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07/03/2024 at 8:00 am Licensing Program Analyst (LPA) David España initiated a case management follow-up at the location listed above. LPA Espana met with Stephanie Brown, administrator and explained the purpose of the visit was to follow-up on an incident that occurred on 4/25/2024.

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 April 22, 2024, Client #1 called 911 at 5:00 pm stating an unknown perpetrator broke into Client #1’s(C1) room and proceeded to sexually assault C1. Based on the incident report, the Santa Monica Police department took a report and C1 was sent to UCLA Santa Monica for observation. C1 left the hospital before receiving any treatment. The incident report also stated that C1 could not give description of the alleged perpetrator.

LIC 809C continued
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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: 07/03/2024
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CDSS Investigation Branch Department Investigator Philippe Ryan Miles conducted an interview with C1 and reviewed facility files. Per facility files, C1 has made allegations of being sexually assaulted since April of 2022. It was also noted that C1’s primary diagnosis is Schizophrenia. C1 was interviewed by Investigator Philippe Ryan Miles regarding the incident. C1 identified three specific individuals as her alleged attackers, including an ex-boyfriend and a former classmate. C1 stated that she was sexually assaulted by all three, that they would do it frequently while she was sleeping. C1 stated she was sexually assaulted daily for the past year and a half while sleeping. C1 alleged that facility staff are complicit in these attacks by providing access to her room.

No deficiencies were found or cited during this visit.

An exit interview was conducted and a copy of this report was provided to Administrator Stephanie Brown.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
LIC809 (FAS) - (06/04)
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