191603749-4-8-2026-11-AS-EMAZ-DTKQWV-20260428123235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 04/08/2026
Date Signed: 04/08/2026 04:54:20 PM

Substantiated

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
11/14/2025 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251114163704

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: 71	DATE:	04/08/2026
		UNANNOUNCED	TIME BEGAN:	08:23 AM
MET WITH:	Stephanie Brown/Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility is in disrepair.
Facility did not adhere to fire clearance protocols.

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

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 11

Control Number 11-AS-20251114163704

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: 04/08/2026

NARRATIVE

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Investigation Revealed the Following:

Allegation: Facility is in disrepair.

The details of the complaint alleged that the facility is in disrepair.

On April 8, 2026, at approximately 9:00 am, the department conducted a health and safety inspection of the facility. Inspectors randomly selected and observed 10 resident rooms. Several rooms had broken blinds. The department also noted holes in the walls of several rooms. In addition, all rooms had issues with smoke detectors; either the detectors were missing or the batteries were not functioning. The affected room numbers are: 24A, 24B, 23C, 26C, 26B, 15C, 14C, 12, 12A, and 12B.

Allegation: Facility did not adhere to fire clearance protocols.

The details of the complaint alleged that the smoke detectors at the facility are missing or in disrepair.

On April 8, 2026, at approximately 9:00 am, the department conducted a Health and Safety check of the facility. During the inspection, the department randomly selected and observed 10 resident rooms. Upon review, it was found that all 10 rooms had issues with smoke detectors; either the detectors were entirely missing, or the devices present had non-functioning batteries. The affected room numbers are as follows: 24A, 24B, 23C, 26C, 26B, 15C, 14C, 12, 12A, and 12B.

During this investigation, LPA found sufficient evidence to support the above-mentioned allegation.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D).

An exit interview was conducted, and a copy of the Complaint Report was given to Stephanie Brown/Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 11

Control Number 11-AS-20251114163704

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/08/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/09/2026 Section Cited CCR 80072(a)(2)	1 2 3 4 5 6 7	(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, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Licensee will adhere to Title 22 at all times. As a plan of correction, the licensee will replace the missing smoke detectors and put batteries in the ones that were missing one. Proof of correction will be sent to the department by the POC due date.
	8 9 10 11 12 13 14	Based on observation, licensee failed to ensure smoke detectors inside clients rooms are always in place or in good repair. This Poses an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14
Type B 04/27/2026 Section Cited CCR 80087(a)	1 2 3 4 5 6 7	80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Licensee will adhere to Title 22 at all times. As a corrective action, the licensee will repair the hole in the wall and the broken blinds. Proof of correction will be sent to the department via email before the POC due date.
	8 9 10 11 12 13 14	Based on observation, licensee failed to ensure facility is in good repair at all times. This poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14

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: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 11

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
11/14/2025 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251114163704

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: 71	DATE:	04/08/2026
		UNANNOUNCED	TIME BEGAN:	08:23 AM
MET WITH:	Stephanie Brown/Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Questionable death.
Staff did not seek medical attention for resident in a timely manner.
Staff did not safeguard resident's personal belongings.
Staff did not administer residents' medications as prescribed.
Staff did not ensure that the facility was free of pests.
Staff did not provide responsible party with resident's medical records.

INVESTIGATION FINDINGS:

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On 4/8/2026, at approximately 8:30 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Stephanie Brown/Administrator. LPA Iniguez explained the purpose of this visit.
Investigation Consisted of: the department conducted the following interviews: Administrator interview, (A#1), Clients Interviews (C#1-C#8), and Staff interview (S#1-S#3). The department gathered the following documents: copy of Medical Examiner Death Investigation Report #2025-11231 dated:7/14/25, copy of Register of Facility Clients or LIC 9020 dated: November 2025, copy of Personnel Report or LIC 500 dated: November 2025, Copy of (C#1)’s Physician Report for Community Care Facilities or LIC 602 dated: 1/3/13, copy of (C#1)’s admission agreement dated: 1/22/08, copy of Identification and Emergency Information or LIC 601 dated:1/22/24, copies of facility staff First Aid/CPR certification cards various dates, copy of one of (C#1)’s most recent admission agreements dated 1/1/2024. copy of (C#1)’s Client/Resident Personal property and Valuables or LIC 621 no date, copies of (C#1) Medication Administration Records-MARs various dates, and copies of the service report by pest control company dated: 1-2026 to 04-2026.
Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 11

Control Number 11-AS-20251114163704

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: 04/08/2026

NARRATIVE

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Investigation Revealed the Following:

Allegation: Questionable death.

The details of the complaint alleged that (C#1) experienced a questionable death while at the facility

On April 7, 2026, during the records review, the Department observed the copy of the Medical Examiner Death Investigation Report #2025-11231, dated July 14, 2025. The Department noted that the County of Los Angeles Department of Medical Examiner reported that foul play was not suspected in the death of (C#1). The Medical Examiner classified (C#1)’s death as natural.

Allegation: Staff did not seek medical attention for resident in a timely manner.

The details of the complaint alleged that the facility did not check on (C#1) on a regular basis while living at the facility

On April 8, 2026, during the records review, the Department reviewed copies of facility staff First Aid/CPR certification cards. The Department observed that all cards were current and unexpired, and confirmed that all facility staff who have direct contact with clients possessed valid First Aid/CPR certification. In addition, the department observed the copy of (C#1)’s most recent admission agreements dated 1/1/2024. It is written that as part of the basic services the facility will generally observe the residents/clients’ physical and emotional health.

On April 8, 2026, during an interview with the facility Administrator (A#1), (A#1) she stated that the facility’s written protocol for resident wellness checks includes staff conducting rounds every hour during daytime hours and every 30 minutes during nighttime hours. Regarding the incident involving (C#1), (A#1) it reported that on the day of the event, staff were informed that (C#1) was not feeling well and were asked to check on them. When staff entered (C#1)’s room, they found (C#1) unresponsive. (A#1) stated that staff immediately contacted emergency services and initiated CPR. Upon arrival, emergency personnel assessed (C#1) and pronounced them deceased at the scene.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 11

Control Number 11-AS-20251114163704

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: 04/08/2026

NARRATIVE

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On April 8,2026, the department could not speak with (C#1) since they passed away on 7/12/25.

On April 8,2026, during interviews with clients in care (C#2-C#8), (7) out of (7) clients stated that that when they feel sick or require medical assistance, facility staff respond appropriately and provide help. In addition, (7) out of (7) clients also reported that there has never been a time when they felt they needed medical attention and did not receive assistance in a timely manner.

On April 8,2026, during interviews with facility staff (S#1-S#3), (3) out of (3) stated that the facility’s procedure for monitoring residents includes conducting routine checks throughout the day and observing residents during daily tasks. Staff reported that if a resident appears ill or in need of medical attention, they are trained in CPR and are instructed to contact emergency services immediately. In addition, (3) out of (3) staff stated that they did not observe (C#1) appearing sick or in need of immediate medical attention prior to the incident. Staff reported that (C#1) generally appeared well and did not show indications of distress or illness before the event.

Allegation: Staff did not safeguard resident's personal belongings.

The details of the complaint alleged that the facility failed to safeguard (C#1)’s personal belongings

On April 8, 2026, during the records review process, the department reviewed a copy of one of (C#1)’s most recent admission agreements, dated 1/1/2024. The department noted that it is written in the admissions agreement under the Miscellaneous terms and conditions: the facility will not be responsible for any theft or other manner of loss, or any damage thereof, of cash resources, valuables or personal property brought into the facility unless these items are delivered and registered for safekeeping with the office prior to any report of loss, and there is negligence on the facility part. This agreement was signed by (C#1) on 1/1/2024. In addition, the department observed a copy of (C#1)’s Client/Resident Personal Property and Valuables or LIC 621, no date. The department noted that (C#1) listed only one item: a cell phone, a TV, a queen bed, a clock radio, a DVD player, and a TV stand. The department did not observe the purse listed on it.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 11

Control Number 11-AS-20251114163704

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: 04/08/2026

NARRATIVE

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On April 8,2026, during an interview with the facility administrator (A#1), (A#1) stated that the facility’s procedures for inventorying and securing resident personal belongings include asking each resident upon admission whether they wish to have their personal items safeguarded by the facility. If residents choose to participate, their belongings are stored in designated lockers located in the facility office. If residents decline, they may keep their belongings in their rooms and assume responsibility for them. Regarding (C#1), (A#1) reported that after (C1)’s passing, the facility was not aware that any of (C1)’s personal belongings, including (C1)’s cellphone or purse, were missing. (A#1) stated that it was possible the coroner’s office collected (C#1)’s belongings as part of their investigative process. (A#1) further stated that (C#1)’s room was sealed by the coroner’s office, and the facility ensured the room remained sealed as directed.

On April 8,2026, the department could not speak with (C#1) since they passed away on 7/12/25.

On April 8,2026, during interviews with clients in care (C#2-C#8), (7) out of (7) clients stated that that they feel their personal belongings are safe at the facility. When asked if any of their items had ever gone missing or been misplaced while living at the facility, (7) out of (7) clients reported that they had not experienced missing or misplaced belongings.

On April 8,2026, during interviews with facility staff (S#1-S#3), (3) out of (3) stated that the facility’s process for documenting, storing, and safeguarding residents’ personal belongings includes reminding residents to keep their items locked and always secured. Staff reported that residents are also encouraged to leave valuables in their rooms rather than taking them outside the facility. When asked about any issues or reports concerning Client #1’s (C#1) personal belongings, (3) out of (3) facility staff stated that they were not aware of any reports from (C#1) regarding missing or misplaced items.

Allegation: Staff did not administer residents' medications as prescribed.

The details of the complaint alleged that the facility mismanage (C#1)’s medications.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 11

Control Number 11-AS-20251114163704

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: 04/08/2026

NARRATIVE

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On April 8, 2026, during the records review, the Department reviewed copies of Client #1’s (C#1) Medication Administration Records (MARs) for various dates. The Department observed no discrepancies in the documentation of medication administration for (C#1). Additionally, the Department noted that (C#1) did not always adhere to their prescribed medication regimen, as there were documented instances in which (C#1) refused to take their medications.

On April 8,2026, during an interview with the facility administrator (A#1), (A#1) stated that there were no discrepancies identified in (C#1)’s medications, Medication Administration Records MARs, or physician orders during the period in question. When asked whether there were any missed, late, held, or altered doses for (C#1), (A#1) reported that (C#1) sometimes refused to take their prescribed medications. (A#1) stated that when (C#1) refused medication, staff documented the refusal on the MARs in accordance with facility procedures.

On April 8,2026, the department could not speak with (C#1) since they passed away on 7/12/25.

On April 8,2026, during interviews with clients in care (C#2-C#8), (7) out of (7) clients stated that they receive their medications every day as expected. When asked whether they had ever missed a medication dose, received it late, or noticed anything unusual about how their medications were administered, (7) out of (7) clients reported that they had not experienced any such issues.

On April 8,2026, during interviews with facility staff (S#1-S#3), (3) out of (3) stated that the facility’s medication administration process includes administering all medications from the office and documenting each dose on the Medication Administration Records (MARs) to ensure accuracy and compliance with physician orders. When asked whether there were any challenges, discrepancies, or incidents related to (C#1)’s medications during the period in question, (3) out of (3) staff reported that (C#1) typically took their medications as prescribed. Staff stated that there were occasional instances in which (C#1) refused to take their medications, and these refusals were documented on the MARs in accordance with facility procedures.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 8 of 11

Control Number 11-AS-20251114163704

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: 04/08/2026

NARRATIVE

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Allegation: Staff did not ensure that the facility was free of pests.

The details of the complaint alleged that the facility is not free of pests.

On April 8, 2026, during the records review, the Department reviewed copies of the pest control service reports dated January 2026 through April 2026. The Department observed that the facility has an active contract with a pest control company, which provides twice a month pest control services inside clients’ rooms, surrounding areas of the facility, and additional services on an as-needed basis.

On April 8,2026, during an interview with the facility administrator (A#1), (A#1) stated that the facility’s pest control procedures include having a contracted pest control company provide services twice a month, as well as additional services on an as-needed basis when concerns are reported. When asked whether there had been any recent reports or observations of pests in the facility, (A#1) stated that there had been no reports from clients regarding pests at the facility.

On April 8,2026, the department could not speak with (C#1) since they passed away on 7/12/25.

On April 8,2026, during interviews with clients in care (C#2-C#8), (3) out of (7) clients stated that they had seen some type of pest inside their rooms. Additionally, (7) out of (7) clients stated that they would inform the facility if they saw or noticed the presence of pests anywhere in the facility.

On April 8,2026, during interviews with facility staff (S#1-S#3), (3) out of (3) stated that they had not observed any pests in the facility recently. Also, staff reported that the facility’s procedure for responding to pest concerns includes immediately notifying the Administrator if a client or staff member reports a pest issue. In addition, (3) out of (3) staff stated that they had not needed to follow this procedure recently, as no pest reports had been brought to their attention.

Allegation: Staff did not provide responsible party with resident's medical records.

The details of the complaint alleged that the facility failed to comply with the request for medical records for (C#1)’s responsible party

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 9 of 11

Control Number 11-AS-20251114163704

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: 04/08/2026

NARRATIVE

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On April 8, 2026, during the records review process, the department did see the original records request that was faxed on 11/10/2025. The department informed (C#1)’s representative that if they could fax the request while they are at the facility, they could check whether the facility received the second request (C#1)’s re-faxed request.

On April 8,2026, during an interview with the facility administrator (A#1), (A#1) stated that when the facility receives a subpoena for medical records, staff gather the requested documents and submit them to the requesting party in accordance with the instructions provided. When asked whether the facility received a request from (C#1)’s responsible party for medical records, (A#1) stated that the facility had not received any formal or official request for (C#1)’s medical records.

On April 8,2026, the department could not speak with (C#1) since they passed away on 7/12/25.

On April 8,2026, during interviews with clients in care (C#2-C#8), (7) out of (7) clients stated that they had either requested their medical records in the past or believed their responsible party could request them if needed. Clients who had made requests stated that staff were helpful and provided the records without issue, and others stated they believed the staff would provide them. Additionally, (7) out of (7) clients reported that they were not aware of any situation in which a resident or responsible party requested medical records and did not receive them.

On April 8,2026, during interviews with facility staff (S#1-S#3), (3) out of (3) stated that to their understanding, the facility would provide medical records to a responsible party upon request, in accordance with facility procedures. When asked whether the facility had received a request from (C#1)’s responsible party for medical records, (3) out of (3) staff stated that they were not aware of any such request being submitted to the facility.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 10 of 11

Control Number 11-AS-20251114163704

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: 04/08/2026

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During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Stephanie Brown/Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026

LIC9099 (FAS) - (06/04)

Page: 11 of 11