191671691-7-21-2026-11-AS-JHAD-DWNQ9D-20260805115809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191671691
Report Date: 07/21/2026
Date Signed: 07/21/2026 04:39:01 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
07/15/2026 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260715134617

FACILITY NAME:	CROFTON MANOR INN		FACILITY NUMBER:	191671691
ADMINISTRATOR:	AMALIA ESQUIVIAS		FACILITY TYPE:	740
ADDRESS:	1950 E. 5TH ST.		TELEPHONE:	(562) 437-0093
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	213; 213	CENSUS: 119	DATE:	07/21/2026
		UNANNOUNCED	TIME BEGAN:	12:33 PM
MET WITH:	AMALIA ESQUIVIAS		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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Staff are interfering with a resident's visitations.

INVESTIGATION FINDINGS:

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On July 21, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced complaint visit., AMALIA ESQUIVIAS the Administrator, greeted the LPA and explained that the purpose of the visit was to investigate the allegation mentioned above.

The investigation involved collecting documents and inspecting the facility. A review was conducted of the Facility Personnel Roster (dated July 16, 2026), the Facilty Resident Roster (dated July 16, 2026). Resident #1 (R1's) Medical Assessment for (RCFE) LIC 602A (dated June 22, 2026), Identification adn Emergency Information LIC 601 (dated October 05, 2022), Notice of Revocaton of Powere of Attorney (dated July 12, 2026), Durable Power of Attorney (dated December 8, 2021) and other pertinent records associated with this complaint. Interviews with Resident #1-#10, Staff #1 and Witness #1.
(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

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-20260715134617

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: CROFTON MANOR INN	FACILITY NUMBER: 191671691
	VISIT DATE: 07/21/2026

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

ALLEGATION: Staff are interfering with a resident's visitations.

It is alleged that staff are interfering with Resident #1 (R1)'s visitation. Reports indicate that (R1) is unable to leave the facility or that visits are restricted to family members. Further reports indicate that the Power of Attorney imposes visitation restrictions for (R1). Additional reports indicate that on July 12, 2026, a Notice of Revocation of Power of Attorney was offered to the facility, and it was denied by the administrator, further preventing visits with (R1). No further information is available.

On July 15, 2026, between 12:33 PM and 1:30 PM, the Department interviewed staff member identified as Staff #1 (S1). (S1) is unable to support this claim. (S1) noted that Resident #1 (R1), a participant in Welbe Health is being managed by health and social professionals through the health program. (R1) has had a Durable Power of Attorney for Health Care (DPOA-HC) in place since 2021. This document grants authority to make personal care decisions, including visitation, and explicitly restricts (R1) from leaving the facility with certain family members. Under the directives of DPOA-HC, a family member is allowed to visit (R1) within the facility, but they cannot take R1 out of the facility.

(S1) also mentioned that the facility has proof of (R1's) incapacity and a copy of the (DPOA-HC) specifying this authority on file. Furthermore, (S1) noted that on July 12, 2026, the facility was served with a Notice of Revocation of Power of Attorney for (R1), which was notarized on the same day to override the current (DPOA-HC). However, (S1) claimed that they were unable to accept the legal documents because (R1's) medical records indicate that (R1) lacks the clinical or legal capacity to make decisions and is incapacitated due to (R1's) diagnosis with Major Neurocognitive Disorder. (S1) stated that they contacted the Welbe Health Care Team the following day and have an in-person conference set for July 17, 2026, which includes the current (DPOA-HC), Social Worker, Medical Physician, (R1), and the potential (POA) to address and clarify this matter promptly. A follow-up interview with (S1) on July 20, 2026, confirmed the Care Team Conference discussion on the Power of Attorney and visitations and that all parties have reached an agreement.

On July 15, 2026, between 01:50 PM and 04:30 PM, the Department interviewed residents identified as Resident #1 through Resident #10 (R1-R10). Ten (10) out of ten (10) resident members cannot corroborate this claim. (R1-R10) confirmed that staff does not interfere with visits. They unanimously assert that no staff members impose limits or restrictions on their visits.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260715134617

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: CROFTON MANOR INN	FACILITY NUMBER: 191671691
	VISIT DATE: 07/21/2026

NARRATIVE

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Furthermore, no staff member has discouraged residents from visiting specific individuals. All residents confidently expressed that they feel their visits are private and welcoming to friends or family.

(R1) stated that there are open visitations at the facility and in the community for friends and family. (R1) is not aware of any visitation restrictions. (R1) stated to have the ability to leave the facility three days a week to attend day program activities with no restrictions. Although (R1) does not recall signing a legal document on July 12, 2026, (R1) acknowledged that the signature appeared authentic but is uncertain. (R1) could not remember when the last family visit occurred.

On July 20, 2026, between 11:52 AM and 12:02 PM, the Department interviewed witness member identified as Witness #1 (W1). (W1) confirmed that a Care Conference meeting took place on Friday, July 17, 2026, with the participation of the Welbe Health Care Team and all relevant parties. While (W1) is unable to share the specific details discussed during the meeting, (W1) did convey that the Notice of Revocation of Power of Attorney has been deemed invalid based on (R1’s) mental capacity.

The Department reviewed the Durable Power of Attorney (dated 12/08/21), Notice of Revocation of Power of Attorney (dated 07/12/26), (R1’s ) Identification and Emergency Information LIC 601 (dated 10/05/22), Medical Assessment for Residential Care Facilities for the Elderly and LIC 602A (dated 06/22/26), Resident Appraisal LI C 603A (dated 01/18/26), Individual Service Plan (dated 02/24/26) verified (R1’s) diagnosis with Major Neurocognitive Disorder and is unable to leave the facility unsupervised due to unsafe wandering behavior.

Further review of email communications from (S1) and Welbe Health (dated 07/13/26) and the Visiting/Outing Log (dated 07/01/26 – 07/15/26) verified that (R1) received visits on July 12 and 13, 2026, and left the facility with a visitor on July 13, 2026.

Based on the gathered information, there is insufficient evidence to corroborate the allegation.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

No deficiencies cited.

An exit interview was conducted with AMALIA ESQUIVIAS, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

LIC9099 (FAS) - (06/04)

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