191603749-8-4-2022-11-AS-EMAZ-CHW3SD-20220902183007

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 08/04/2022
Date Signed: 08/04/2022 03:53:47 PM

Unsubstantiated

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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2021 and conducted by Evaluator Stephanie Cifuentes

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210325085527

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: 124	DATE:	08/04/2022
		UNANNOUNCED	TIME BEGAN:	01:18 PM
MET WITH:	Stephanie Brown-Adminstrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Client sustained a pressure injury while in care
Client's room in not properly maintained while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at the facility listed above. LPA spoke with Administrator Stephanie Brown via telephone call prior to entering the facility to conduct risk assessment questionnaire and was informed that facility has no COVID cases nor do any of the clients have symptoms. LPA arrived at facility and was greeted by staff Stephanie Brown. LPA explained the purposed of the visit was to deliver findings for the allegations listed above and was granted access to the facility.

The investigation consisted of the following: On 3/26/2021 LPA spoke with administrator and was given a virtual tour of the facility. LPA was shown office, clients, apartments, lounge/dining room, outside shaded area and kitchen. On 6/23/2021 and on 4/14/2022 LPA spoke with W1. LPA interviewed clients (C2-C11) and staff (S1-S6). LPA Cifuentes requested the following information: Client roster, staff roster and other documents relevant to the investigation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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-20210325085527

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
MONTERY PARK, CA 91754

FACILITY NAME: MANOR, THE	FACILITY NUMBER: 191603749
	VISIT DATE: 08/04/2022

NARRATIVE

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Regarding the allegation: Client's room in not properly maintained while in care

It is alleged that client had urine and feces in their room. LPA Cifuentes reviewed records and noted that in admissions agreement under General Basic services it states facility will provide cleaning of clients/resident’s room, comfortable and suitable bed including fresh linen weekly or more if required. LPA toured facility and observed janitor moping the common room, kitchen, counters, sink and cooking area were clean. Dining room floors appeared clean, and storage area was well organized. LPA observed no trash on floors, outdoor benches appeared clean. Front of facility had no trash or cigarette butts. LPA observed one of the clients sweeping the floor of his room. LPA Cifuentes interviewed clients (C2-C11) regarding the allegations. When asked how often their rooms were cleaned, 9 out of the 10 interviewed stated rooms are cleaned weekly. C1 was not available for interview by LPA. LPA interviewed staff (S1-S6) and of those interviewed, 5 out of 6 stated facility clients rooms were cleaned weekly, with their bathrooms cleaned daily. It was also added that depending on the client, some would not allow staff to enter and clean while the client was present. Based on information gathered and service records reviewed, the Department did not find sufficient evidence to support the allegation mentioned above.

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, therefore the allegation is Unsubstantiated.

Exit interview conducted, and a copy of the report was given to Administrator Stephanie Brown.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC9099 (FAS) - (06/04)

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