191603749-4-17-2026-11-AS-UCOL-DTSUPA-20260505154512

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 04/17/2026
Date Signed: 04/17/2026 01:03:34 PM

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
04/10/2026 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20260410114804

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: 107	DATE:	04/17/2026
		UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	ADMIN STEPHANIE BROWN		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not provide information to authorized representative
Staff mismanage resident's medicaiton
Staff mishandled a resident's medications
Staff do not timely address a resident's change in medical condition

INVESTIGATION FINDINGS:

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On 04/17/2026 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to The Manor and was greeted by Administrator Stephanie Brown (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
The investigation consisted of the following: LPA Calderon interviewed Staff S1-S3, residents R1-R10. LPA Calderon obtained the following records: Physician report (dated 08/25/2025), Needs and service plan (dated 10/28/2025), Admission Agreement (dated 10/01/2025), Medication Administration Record (MAR) (dated March, April 2026) for R1. Toured the facility with S1
The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026

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

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260410114804

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: 04/17/2026

NARRATIVE

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Regarding the Allegation: Staff do not provide information to authorized representative.

This complaint alleged that the facility staff did not keep the family members informed of changes to R1 health. Records review indicate the following: Physician report (dated 07/24/2025) indicates that R1 has health issues and cognitive issues. Interviews indicate the following: R1 could not be interviewed due to health issues. R2-R10 deny the allegation. S1 indicates that S1 keeps R1 family members informed of changes to R1 condition and that the communication issues are between the doctor and the family member. S2-S3 deny the allegation.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff do not provide information to authorized representative” is found to be UNSUBSTANTIATED.

Regarding the Allegation: Staff mismanage residents’ medications.

This complaint alleged that the facility staff mismanage residents’ medication. Records review indicate the following: The medication administration record (MAR) (dated March and April 2026) indicates that R1 received medication on time and in the correct amount. There were no missing dates for medication services. Interviews indicate the following: R1 could not be interviewed due to health issues. R2-R10 deny the allegation. S1 indicates that S1 and S1 staff make sure that R1 medications are taken timely and in the correct amount. S2-S3 deny the allegation.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff mismanage residents’ medication” is found to be UNSUBSTANTIATED.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260410114804

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: 04/17/2026

NARRATIVE

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Regarding the Allegation: Staff mishandled a resident’s medication. This complaint alleged that the facility staff mishandled resident medication. Records review indicate the following: The medication administration record (MAR) (dated March and April 2026) indicates that R1 received medication on time and in the correct amount. There were no missing dates for medication services. Interviews indicate the following: S1 indicates that staff use the MAR and that staff did not mishandle R1 medication. S2-S3 deny the allegation. R1 could not be interviewed due to health issues. R2-R10 deny the allegation.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff mishandled a residents’ medications” is found to be UNSUBSTANTIATED.

Regarding the Allegation: Staff do not timely address a residents change in medical condition. This complaint alleged that the facility staff did not address R1 medical condition timely. Records review indicate the following: Physician report (dated 07/24/2025) indicates that R1 has health issues and cognitive issues. Interviews indicate the following: S1 indicates that staff address every resident’s medical condition timely and informs residents family timely. S2-S3 deny the allegation. R1 could not be interviewed due to health issues. R2-R10 deny the allegation.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff do not timely address a residents change in medical condition” 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: 04/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026

LIC9099 (FAS) - (06/04)

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