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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191603749
Report Date: 10/30/2023
Date Signed: 10/30/2023 03:09:21 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, 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
10/23/2023 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 11-AS-20231023120020
FACILITY NAME:MANOR, THEFACILITY NUMBER:
191603749
ADMINISTRATOR:STEPHANIE BROWNFACILITY TYPE:
735
ADDRESS:1905/2019 PICO BOULEVARDTELEPHONE:
(310) 450-1748
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:151CENSUS: 118DATE:
10/30/2023
UNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:STEPHANIE BROWNTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Unlawful eviction.
Staff do not provide a safe environment for residents.
INVESTIGATION FINDINGS:
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On 10/30/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit investigations. Upon arrival at the facility. LPA Richard met with Direct Care/Front Desk Gloria Paras and later was joined with Administrator Stephanie Brown. LPA Richard explained the purpose of today's visit. LPA Richard and Administrator Brown conducted a tour of facility grounds, and interviewed staff 1-5 (S1-S5), clients 2-11 (C2-C11), and witness 1 (W1).


LPA Richard requested and obtained a client roster, staff roster, a client Case manager, Admission Agreement, House Rules, and Thirty days Eviction Notice. LPA Richard requested and reviewed the alleged victim's records.
LPA Richard could not interview the alleged victim (C1) because he was not at the facility. LPA Richard did spoke with the alleged victim case manager. who stated he is working with the administrator to draff a new rule to see if his client could stay at the facility.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
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 3
Control Number 11-AS-20231023120020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MANOR, THE
FACILITY NUMBER: 191603749
VISIT DATE: 10/30/2023
NARRATIVE
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The investigation revealed the following:
Allegation: Unlawful eviction.

The investigation consisted of the following: During the course of the investigation.

On 10/30/2023, LPA Richard Interviewed five staff 1-5 (S1-S5), 1 witness (W1) and Clients 2-11 (C2-C11). S1, and W1 stated the alleged victim (C1) was not giving an unlawful eviction. Staff stated C1 is disrespectful, rude, verbally aggressive towards kitchen staff, security guard, case managers. Staff stated C1 allowing visitor to sleep in the unit overnight, threaten residents and staff, damage to The Manor Property.

On 10/30/23, LPA Richard interviewed ten Clients 2-11 (C2-C11). All stated that they are not aware of any residents being unlawfully evicted. LPA interviewed Witness 1, the alleged victim case manager. (W1) stated, The Manor did give his client thirty day's notice. His client signed the eviction notice. His client refused a copy after he signed it. Witness 1 stated in October his client asked him to get a copy of the eviction notice from the Administrator for him and then the called Licensing and reported that he received the eviction notice second week of October, 2023.

Based on LPA observation, interviews conducted, and records review, the preponderance of evidence standard has not been met. Although the allegation 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 allegation is unsubstantiated.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20231023120020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: MANOR, THE
FACILITY NUMBER: 191603749
VISIT DATE: 10/30/2023
NARRATIVE
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Allegation: Staff do not provide a safe environment for residents.

On 10/30/2023, LPA Richard Interviewed five staff 1-5 (S1-S2), and ten clients 2-11 (C2-C11). S1-S5 and C2-C11 stated that staff is providing clients with a comfortable living environment. S1-S5 and C2-C11 stated clients are provided with safe, healthy, and comfortable accommodations, and staff is meeting clients' needs. C2-C11 stated they were happy with the staff and liked living at the facility. All clients denied having any issues with their safety or staff do not provide a safe environment for residents.

Based on LPA observation, interviews conducted, and records review, the preponderance of evidence standard has not been met. Although the allegation 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 allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to administrator Stephanie Brown.


SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3