<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607966
Report Date: 02/03/2023
Date Signed: 02/03/2023 02:54:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
01/24/2023 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230124090434
FACILITY NAME:VETERANS HOME OF CALIFORNIA - WEST LOS ANGELESFACILITY NUMBER:
197607966
ADMINISTRATOR:JULIAN MANALOFACILITY TYPE:
740
ADDRESS:11500 NIMITZ AVENUETELEPHONE:
(424) 832-8200
CITY:LOS ANGELESSTATE: CAZIP CODE:
90049
CAPACITY:84CENSUS: 56DATE:
02/03/2023
UNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Julian ManaloTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Illegal Eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 2/03/23 at 9:30 am, Licensing Program Analysts (LPA) Perry Scott, Lizeth Villegas, and Licensing Program Manager (LPM) Janae Hammond conducted a complaint visit to the above facility. LPAs and LPM was met by Julian Manalo, Administrator, and the purpose of the visit was explained.

The investigation consisted of the following:

On 2/03/23 at 10:00am, LPA interviewed the administrator, Julian Manalo, staff 1 (S1) and Staff 2-4 and residents 1-6. LPA obtained copies of resident/staff rosters, a copy of residents # 1 file which included (admission agreement, face sheet, code of conduct, eviction notice, and supporting documents).

The investigation revealed the following: Allegation 1 Illegal Eviction

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
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 5
Control Number 11-AS-20230124090434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES
FACILITY NUMBER: 197607966
VISIT DATE: 02/03/2023
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
LPA interviewed administrator, Julian Manalo about the allegation. He stated that he issued an eviction notice to R1 for code of conduct violation for elder abuse under SOC 341 as well as other code of conduct violations.

On 02/03/23 at 10:40am, LPA interviewed S2-S4 about the allegations and 3 of 3 confirmed that R1 was issued an eviction notice for code of conduct violations.

On 02/03/23 at 11:00am-01:00pm, LPAs interviewed R2-R6, and 4 out of 5 all corroborated that R1 was issued an eviction notice.

Based on interviews and record review the administrator failed to serve R1 with an eviction notice in accordance with tittle 22 regulations. Review of the eviction notice dated 12/30/22, revealed the following items were not included in the eviction notice: The eviction notice was missing resources and referrals for R1, and a statement regarding if R1 stays at the facility an unlawful retainer shall be filed. Also, a written copy of the eviction notice was not issued to Community Care Licensing within 5-days. Therefore the allegation is substantiated. Deficiencies cited under California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview conducted and a copy of the report was given to the administrator, Julian Manalo.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20230124090434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES
FACILITY NUMBER: 197607966
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2023
Section Cited
CCR
87224(d)(1)(B)(1)(D)
1
2
3
4
5
6
7
The licensee shall set forth in the notice to quit the reasons relied upon for the eviction...The notice to quit shall include the following information: Resources available to assist ...Referral services...the residential care facility for the elderly must file an unlawful detainer action. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The licensee shall dismiss the eviction notice to resident number one, in writing, and submit a copy of the dismissal by the POC due date of 02/05/23.
8
9
10
11
12
13
14
Based on interviews and record review the licensee failed to serve resident number one with an eviction notice in accordance with tittle 22 regulations. This poses a personal rights risk to residents in care.
8
9
10
11
12
13
14
Type B
02/06/2023
Section Cited
CCR
874224(f)
1
2
3
4
5
6
7
A written report of any eviction shall be sent to the licensing agency within five (5) days. This rerqiurement is not met as evidenced by:
1
2
3
4
5
6
7
The licensee shall review title 22 regulations for evictions and submit a statement to licensing acknowledging understanding of the regulations by POC due date of 02/06/23.
8
9
10
11
12
13
14
Based on interviews and record review the licensee failed to provide a copy of the eviction notice for resident number to licensing within 5 days. This poses a potential personal rights risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
01/24/2023 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230124090434

FACILITY NAME:VETERANS HOME OF CALIFORNIA - WEST LOS ANGELESFACILITY NUMBER:
197607966
ADMINISTRATOR:JULIAN MANALOFACILITY TYPE:
740
ADDRESS:11500 NIMITZ AVENUETELEPHONE:
(424) 832-8200
CITY:LOS ANGELESSTATE: CAZIP CODE:
90049
CAPACITY:84CENSUS: 56DATE:
02/03/2023
UNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Julian ManaloTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff retaliating against resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 2/03/23 at 9:30 am, Licensing Program Analysts (LPAs) Perry Scott, Lizeth Villegas, and Licensing Program Manager (LPM) Janae Hammond conducted a complaint visit to the above facility. LPA was met by administrator, Julian Manalo, and the purpose of the visit was explained.

The investigation consisted of the following:

On 2/03/23 at 10:00am, LPA interviewed the administrator, Julian Manalo, staff 1 (S1) and Staff 2-4 and residents 1-6. LPA obtained copies of resident/staff rosters, a copy of residents # 1 file which included (admission agreement, face sheet, code of conduct, eviction notice, and supporting documents).

The investigation revealed the following: Allegation - Facility staff retaliating against resident in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20230124090434
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES
FACILITY NUMBER: 197607966
VISIT DATE: 02/03/2023
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
LPAs interviewed S1-S4 and 4 out of 4 denied the allegation that the staff retaliated against the resident while in care. LPA interviewed R1-R6 and 1 out of 6 confirmed that they were retaliated against. And 5 of 6 denied the allegation.

LPA reviewed facility records and did not find evidence that the resident was retaliated against. 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.

Exit interview conducted and a copy of the report was given to the administrator, Julian Manalo.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5