197606170-7-22-2023-11-AS-JHAD-CVLMT8-20230912095306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606170
Report Date: 07/21/2023
Date Signed: 07/22/2023 11:12:31 AM

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
08/15/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220815150323

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: 65	DATE:	07/21/2023
		UNANNOUNCED	TIME BEGAN:	02:09 PM
MET WITH:	Magdalena Romero, Admnistrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff made inappropriate comments towards residents
Staff are not providing adequate food service to residents
Facility is not providing comfortable accomodations for residents
Facility chairs are in disrepair
Staff are not safeguarding residents personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Magdalena Romero, Administrator

The investigation consisted of following: Interviews and Record reviews. On 08/23/22, LPA Alvizar, obtained a copy of the current resident’s roster, staff roster, meal menu, resident #1 records. LPA Alvizar, toured the physical plant with assistant administrator, interviewed assistant administrator and R#1-R#6. On 07/13/23, LPA obtained Resident and Staff rosters, R#1 file (ID/emergency information, Admission agreement, Physician's report, Needs and Services Plan, Mars (June and July,) note of property given to R#1, Preplacement appraisal information, Resident appraisal, Resident personal property and valuables, and Menu for (July.) LPA toured the side patio and middle patio (metal chairs no cushions), office, dining room, kitchen, indoor chairs w/cushions throughout facility, A/C working properly at a comfortable 75 degrees, LPA also toured rooms# 4,12, 17, 36, 32, 49.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

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-20220815150323

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: GOLDEN MANOR REST HOME	FACILITY NUMBER: 197606170
	VISIT DATE: 07/21/2023

NARRATIVE

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Part of the 1st floor and 2nd floor have A/C, the entire facility has Heat. The 1st floor with A/C are dining room, kitchen, TV room and Lobby only. The rest of the 1st floor from the front office, room 1 - 21, there is no A/C, fans are provided upon request by residents. 2nd floor with A/C are rooms 45 - 50, and TV room only. The rest of the 2nd floor from room 22 - 44, there is no A/C, fans are provided upon request by residents. The resident's rooms have their own thermostat and can control their own heat. The facility building is an older building and cannot accommodate an entire A/C unit. LPA observed dinner being served. Dinner served was burrito, rice, salsa, fruit (mango) cup, and soup. LPA also observed staff’s inter-action with residents.

Based on the LPA's Soto and Alvizar’s investigation, the investigation revealed the following.

Allegation 1 – Staff made inappropriate comments towards residents. Interviews conducted with S#1 – S#6, communicated that they have never made bad comments toward any client and have not heard any other staff make bad comments to clients either. Interviews conducted with R#2 – R#6, communicated that staff has never been mean to them or said any inappropriate to them. LPA observed the staff inter-acting with clients during dinner, they were all friendly and helpful with the clients. The interviews and observations conducted did not concur with above allegation.

Allegation 2 - Staff are not providing adequate food service to residents. Interviews conducted with S#1 – S#6, communicated that they sometimes eat at the facility and the food is good. They serve the clients good portions of food. If clients request 2^nd’s they serve them more and offer them alternatives if they do not like what is being served. Interviews conducted with R#2 – R#6, communicated that they eat at the facility and the food is good. The staff does a good job with the food. LPA observed the food being served during dinner. The facility served, beef burrito, rice, fruit (mango), and soup. The food serve was of a good portion, enough to satisfy clients. The interviews and observations conducted did not concur with above allegation.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220815150323

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: GOLDEN MANOR REST HOME	FACILITY NUMBER: 197606170
	VISIT DATE: 07/21/2023

NARRATIVE

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Allegation 3 - Facility is not providing comfortable accommodations for residents. Interviews conducted with S#1 – S#6, communicated that the facility does provide comfortable accommodations, some of the clients have A/C and the clients that don’t have fans. They just to request a fan and they give it to them. In fact, a lot of the clients already have fans in their rooms. Interviews conducted with R#2 – R#6, communicated that the facility does provide comfortable accommodations. LPA observed some client’s rooms, and some had A/C and the rest of the rooms had fans in their rooms that the facility provided. Some clients did not need A/C or fans, they preferred to open their doors and windows and let the outside air cool them off. The clients had a nice breeze coming into their rooms. The interviews conducted did not concur with above allegation.

Allegation 4 - Facility chairs are in disrepair. Interviews conducted with S#1 – S#6, communicated that the chairs are all in good repair, none of them are broken, the chairs are comfortable, and they have cushions for more comfort. Interviews conducted with R#2 – R#6, communicated that the chairs are not broken, and they are fine to sit. LPA observed the chairs used in the common areas, most of them had cushions, the chairs in the outside patios did not have cushion, but were still comfortable, LPA sat in the outside chairs, they were comfortable, and not broken. The interviews and observations conducted did not concur with above allegation.

Allegation 5 - Staff are not safeguarding residents’ personal belongings. Interviews conducted with S#1 – S#6, communicated that they have never taken anything from any client, and they do not know about client’s clothes ripping, the clients haven’t complained to them about that. They have not stolen clients' belongings neither". Interviews conducted with R#2 – R#6, communicated that staff has never stolen or taken their belongings. LPA reviewed R#1 personal property and valuables, R#1 did not list or provide any property into the facility for safeguarding. The facility was not responsible for safeguard any belongings for R#1. The interviews conducted and records reviewed did not concur with above allegation.

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.

An exit interview was conducted with Magdalena Romero, Administrator, and a hard copy of report was provided. This report serves as an amendment to clarify finding. It does not supersedes the complaint investigation findings reflected on report created 07/21/23.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023

LIC9099 (FAS) - (06/04)

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