197606170-9-3-2020-28-AS-MVAO-BYHSB7-20210223124329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606170
Report Date: 09/01/2020
Date Signed: 09/03/2020 12:02:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2020 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200320110901

FACILITY NAME:	GOLDEN MANOR REST HOME		FACILITY NUMBER:	197606170
ADMINISTRATOR:	MARK INGBER		FACILITY TYPE:	740
ADDRESS:	3535 OVERLAND AVENUE		TELEPHONE:	(310) 836-0510
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	98	CENSUS: 70	DATE:	09/01/2020
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Mark Ingber		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Food services is inadequate.
Mail services is inadequate.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Glenn Trueman initiated a follow up complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted via Facetime video with Administrator Mark Ingber.
Initial visit was conducted on 3/25/2020 and LPA Trueman conducted a telephone interview with Administrator Ingber at 12:15 PM. LPA also requested copies of Staff and Resident rosters to be emailed to LPA by 3/24/2020.
Today 9/1/2020 tour of the kitchen and food supply was conducted at 10:30 AM and LPA observed a well balanced supply of perishable and non-perishable food supply.
This included. canned vegetables, potatoes, carrots, celery, 3 cases of eggs, chicken, turkey, pork, ground meat and brocoli.
At 11:00 AM Residents 1-6 were interviewed and Staff 1-4 were interviewed,
In regards to the food service is inadequate based on interviews conducted with 6 residents who all stated

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020

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 2

Control Number 28-AS-20200320110901

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: GOLDEN MANOR REST HOME	FACILITY NUMBER: 197606170
	VISIT DATE: 09/01/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

the quality of the food is good and the temperature is just right.
They all stated there is plenty food and there is not a limited supply of food and specifically not limited in eggs and salads.
4 of 6 residents stated that the food served is what is posted on the menu.
2 of the 6 interviewed stated they do not look at the menu.
Staff interviewed stated that there is a sufficient supply of food and there are no limitations on any food products.
Staff also stated that they will stick with the menu and on a rare occasion if it needs to be changed it will be whited out and residents are made aware.
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 allegations are: Unsubstantiated.
In regards to the allegation Mail services is inadequate, based on interviews conducted with residents all 6 residents stated they have had no difficulty with staff delivering the mail.
They also stated that because of the pandemic the postal service has come less frequently and said that staff will even go to the post office to go get mail and that the postal service told the residents that mail is slow.
Also stated that pre-pandemic the postal service came daily.
Staff interviewed stated that mail delivery is less frequent and because of the pandemic the postal service wants to come in the facility less frequently.
LPA observed via pictures from the Administrator a bulk supply of mail in the office that had to be sorted out so important facility documents are not mixed up with resident mail and once completed 3 staff are assigned to deliver the mail.
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 allegations are: Unsubstantiated.

Reports e-mailed to Administrator for signature.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 2