191603749-10-25-2022-11-AS-UCOL-CLDQZ3-20221121113605

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 10/25/2022
Date Signed: 10/25/2022 01:46:44 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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2022 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221003134508

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: 144	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Stephanie Brown		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff make inappropriate comments towards residents
Staff provokes residents
Staff are forcing residents to take medications
Resident has bed bugs
Unlawful eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation to deliver findings. LPA Agard met with Stephanie Brown, Administrator. LPA Agard explained the purpose of this visit is to deliver the findings for the above complaint allegations.

The investigation consisted of the following: On 10/12/2020, LPA Agard conducted a tour of the facility grounds for the main building and Annex. The main building is a three-story building with 33 client apartments, each containing between 2 and 4 separate rooms and a bathroom. There is a courtyard with a fenced and locked pool, a staff break room, a kitchen, dining room and activity room. LPA Agard requested the following documents which were received at the time of the visit. 1) A copy of the staff roster, 2) a copy of the client roster. 3) Any records for R1. LPA conducted interviews and reviewed documentation.

On 10/25/2022 LPA delivered findings.
Cont on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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-20221003134508

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: 10/25/2022

NARRATIVE

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The investigation revealed the following: Regarding the allegation, staff make inappropriate comments towards residents. “It’s being alleged a staff was verbally abusive to the residents.” LPA Agard interviewed 7 out of 143 clients. 6 out of 7 clients denied the allegation. C1 states, “that’s right, S1 makes inappropriate comments to me. It’s a bad word that you wouldn’t understand.” C2 states, “no, they are pretty good about that kind of stuff. They treat us with respect.” C5 states, “no I’m not familiar with that.” C6 states, “no I haven’t observed that.” C7 states, “the staff, no never, they are really nice.”

During interviews with staff, LPA Agard interviewed 3 out of 26 staff. 3 out of 3 staff denied the allegation. S1 states, “no one makes inappropriate comments to C1. C1 has not resided at the facility for almost 10 years.” S2 states, “staff really don’t say much to C1, but they call and harass S1. S3 states, “I’ve never observed any staff making inappropriate comments towards residents. I know C1 was always yelling and saying things I didn’t understand. During an interview with a witness, W1 states, “my relative has mental health problems. They have not lived there in over 8 years and has not been back since. So, I wouldn’t say it’s true.”

Regarding the allegation: Staff provokes residents. It’s being alleged that staff provoke residents to get them mad. 6 out of 7 clients denied the allegation. C1 states, “they would curse at me and then I would be provoked. I don’t remember but S1 did something wrong.” C2 states, “never provoked. I have had differences of opinions about things here.” C3 states, “nor have I observed any staff provoking residents to get them upset. They treat me fine.” C4 states, “I have not observed staff trying to get any resident upset.” C6 states, “never observed staff trying to provoke any residents or me.” C7 states, “no, never seen that.”

During interviews with staff, 3 out of 3 staff denied the allegation. S1 states, “nope, staff are not provoking C1 or any residents for that matter. Staff don’t curse at them; they curse at us.” S2 states, “I have no clue about anyone provoking C1. That’s not true.” S3 states, “staff don’t provoke residents and I don’t think clients provoke staff, but C1 would yell and curse. During an interview with a witness, W1 states, “I wouldn’t know if staff provoked my relative because I’m not there and they never said anything about that.”

Regarding the allegation: Staff are forcing residents to take medications. “It’s being alleged that staff are forcing clients to take medication. 6 out of 7 clients denied the allegation. C1 states, “they would call the police and the police would make me take the medication in front of them.” C2 states, “no, but I hope people

cont on 9099C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221003134508

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: 10/25/2022

NARRATIVE

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are compliant. They will for example, hand you a cup of water expecting that you are going to take it, but they are not forcing me to take them. C3 states, “I don’t need to be forced; I take my meds. I’ve never observed them forcing anyone else.” C7 states, “no, they never do that they just ask you to take it.

During interviews with staff, 3 out of 3 staff denied the allegation. S1 states, “C1 was taking their meds on and off, but we never forced them. When they didn’t take their meds, they would have a hard time and more behaviors. S2 states, “not at all, we remind, encourage but we don’t force. If they refused, we communicate that to the parties involved and that’s about it. S3 states, “we remind them to take their meds but if they don’t want to, we can’t do anything.” During an interview with a witness, W1 states, “that part I don’t know, but there was an incident when they called me and told me that C1 was not taking their medication. I told C1 that they needed to take it because it was a requirement for them to stay there. I told C1 if they didn’t, they would let them go.

Regarding the allegation: Resident has bed bugs. It’s being alleged the facility has/had bed bugs. 6 out of 7 clients denied the allegation. C1 states, “the facility had bedbugs. They tried to solve the problem but there were a lot of them.” C2 states, “it’s an ongoing issue but nothing in my room. In the past, they loved to bite me, but I haven’t been bitten in over a year and a half. They do a good job staying on top of the bugs but it’s impossible to get rid of them. In a couple years, I haven’t seen them. They check and spray regularly. C3 states, “I haven’t observed bugs in a while. They spray for it on a regular.” C6 states, “occasionally in the past but not anymore. They come every Tuesday to spray.” C7 states, “I’ve never had any. There are people that come from the streets and they are not clean so it’s possible, but I never had them.”

During interviews with staff, 3 out of 3 staff denied or couldn’t confirm the allegation. S1 states, “when C1 was here, they didn’t have bed bugs. I don’t remember when we started treating for them and they never complained about bugs back then.” S2 states, “It could have been but I’m not sure. We don’t have treatment records from back then.” S3 states, “I don’t really remember. It’s been so long.” During an interview with a witness, W1 states, “I can’t remember if C1 complained about bed bugs. I really don’t know.”

Regarding the allegation: Unlawful eviction. It’s being alleged that a resident was evicted by the facility. 6 out of 7 clients denied the allegation. C1 states, “they called the police on me. They’ve called the police on me several times and they dragged me to the hospital. While I was at the hospital, they evicted me for no
Cont on 9099C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221003134508

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: 10/25/2022

NARRATIVE

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reason. I don’t think I have a letter.” C2 states, “I don’t know what would be lawful because this place is different from a residential home. Let me go the other way and say there are people here that need to be evicted. They are not getting rid of people that they need to but to answer the question, no.” C3 states, “I don’t know of anyone being evicted.” C5 states, “I have not observed any evictions.” C7 states, “no, never seen anyone being unlawfully evicted.”

During interviews with staff, 3 out of 3 staff denied or couldn’t confirm the allegation. S1 states, “I’m not sure if C1 was evicted. It was a different administrator at that time. The last thing I have on them was a hospitalization in March of 2012. I don’t have a 30-day notice in our system for them. S2 states, “I don’t think C1 was evicted. I think they left on their own, but I could be mistaken.” S3 states, “I don’t know if C1 was evicted.”

During record review, LPA reviewed a staff roster dated August 2022 that coincides with the staff interviewed. LPA reviewed a resident roster, not dated, that coincides with the residents interviewed. LPA observed C1 not listed on the roster. It was determined the client has not resided at the facility since April 2014. LPA toured occupied and unoccupied units within the facility and did not observed any bedbugs on mattresses or anywhere throughout the facility. Records for bedbug treatments for 2014 are no longer available for review. LPA was unable to obtain a copy of an unlawful eviction for C1.

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is unsubstantiated.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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