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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606170
Report Date: 10/16/2025
Date Signed: 10/16/2025 03:31:24 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
08/06/2025 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250806090400
FACILITY NAME:GOLDEN MANOR REST HOMEFACILITY NUMBER:
197606170
ADMINISTRATOR:MARK INGBERFACILITY TYPE:
740
ADDRESS:3535 OVERLAND AVENUETELEPHONE:
(310) 836-0510
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:98CENSUS: 60DATE:
10/16/2025
UNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Maggie RomeroTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee does not ensure that facility elevator(s) are in good repair.
INVESTIGATION FINDINGS:
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On 10/16/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an subsequent visit to change the finding determination issued on 08/13/25 on the above allegation. LPA met with Office Staff Maggie Romero and spoke with Assistant Administrator Judith Muro over the phone and the purpose of the visit was explained.

Investigation consisted of the following: On 08/13/2025, LPA obtained Personnel Report (dated 04/16/25), Register of Residents, and a business card of the former elevator company. LPA interviewed Staff #1 – 2, Witness #1 – 2, and Residents #1 – 7, and observed the elevator. On 09/19/25, LPA received an Elevator Invoice (02/16/25) and application for elevator plan check and inspection (paid 09/15/25). On 10/06/25, LPA interviewed Witness #2. Note: LPA left a voicemail for Witness #1 and Resident #6 was unavailable.

Continue to LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
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 11-AS-20250806090400
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: GOLDEN MANOR REST HOME
FACILITY NUMBER: 197606170
VISIT DATE: 10/16/2025
NARRATIVE
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Investigation revealed the following:

Allegation: Licensee does not ensure that facility elevator(s) are in good repair.

Record review of elevator invoice (02/16/25) revealed that a portion of the deposit for a new elevator had already been paid. Record review of the application for elevator plan check and inspection was paid on 09/15/25. On 10/06/25, interview with Elevator Vendor (W2) indicated that the elevator was working in February 2025 but not properly. W2 indicated W2 would visit the facility to service the elevator whenever there was an issue. W2 indicated that the project started 1 – 2 months after the elevator invoice date. On 08/13/25, interview with the Administrator indicated that the elevator has been down for at least four weeks and W2 was waiting for a particular piece. W2 indicated that W2 anticipates the permit to be approved next week and the elevator to be completed in two months. Six out of six resident interviews (R1-R5, R7) indicated they take the stairs and are still able to receive services.

Regarding the allegation, “Licensee does not ensure that facility elevator are in good repair,” based on record review and interviews, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Judith Muro over the phone and a copy of this report was provided to Office Staff Maggie Romero.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2