197608333-7-6-2022-31-AS-EMIR-CHCU9Q-20220816152331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608333
Report Date: 07/06/2022
Date Signed: 07/06/2022 02:37:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20220308135916

FACILITY NAME:	MANOR HOUSE OF ANTELOPE VALLEY		FACILITY NUMBER:	197608333
ADMINISTRATOR:	SEAN MENDOZA		FACILITY TYPE:	740
ADDRESS:	45550 11TH ST., W.		TELEPHONE:	(661) 951-2085
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	6	CENSUS: 5	DATE:	07/06/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Sean Mendoza		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff threaten a resident with eviction while in care
Staff speak inappropriately towards a resident while in care
Resident's personal finances are being mishandled while in care
Resident's medication is being mishandled while in care
Staff mistreated a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Evelin Rios and Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. The 10 day visit was made on 3/11/2022. During the course of the investigation, interviews and record review were made.

Staff threaten a resident with eviction while in care:
In regards to the allegation, according to the administrator, Sean Mendoza, an eviction was never issued. Administrator only mentioned that he's approached Resident 1 (R1) about the house rules, and to be sure to comply, but he's never issued an eviction. LPAs interviewed R1, who denied ever being issued an eviction. Based on the interviews, there was insufficient evidence to prove that staff threatened resident with an eviction. Therefore, the allegation is Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

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 31-AS-20220308135916

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MANOR HOUSE OF ANTELOPE VALLEY	FACILITY NUMBER: 197608333
	VISIT DATE: 07/06/2022

NARRATIVE

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Staff speak inappropriately towards a resident while in care/Staff mistreated a resident while in care:
In regards to the above allegations, per interview with Sean, neither he or his staff have mistreated the residents in care, or speak to residents inappropriately. There were no witnesses to confirm the allegation to date, place and time. LPAs interviewed the residents in care, and they also denied ever being mistreated or spoken to inappropriately. Based on the information obtained, there was insufficient evidence to confirm that residents are spoken to inappropriately or mistreated. Therefore, the allegations are deemed Unsubstantiated at this time.

Resident's personal finances are being mishandled while in care:
In regards to the allegation, it was reported that the administrator, is overcharging R1 monthly. According to the administrator, he only charges the resident a fee of $1025 per month. Administrator adds that he doesn't handle resident finances. Review of R1's Admission Agreement confirms the fee. In addition, interviews with residents do not corroborate with the allegation. Therefore, based on the information obtained, it could not be proven that the resident's personal finances are being mishandled. The allegation is deemed Unsubstantiated at this time.

Resident's medication is being mishandled while in care:
In regards to the allegation, it was reported that R1 wasn't getting their refill prescription as prescribed. Review of R1's medication sheet indicate that R1 was receiving their medication as prescribed through April 2022 with no discrepancies. According to the administrator, he has encouraged R1 to make an appointment with their doctor so that the doctor can prescribe R1 their refills. R1 has refused. Administrator has documented the refusal, informed R1's responsible party, and notified APS of the refusal and self-neglect. APS has yet to respond to the administrator. LPA's interviewed R1, who admitted their refusal to go to the doctor to get a refill prescription. LPAs did interview the other residents, who revealed they had no complaints or concerns with getting their medications. Although there was admission that R1 hasn't been getting their refill, there was evidence that administrator has attempted, and encouraged R1 to making an appointment with their doctor. Furthermore, R1 admitted that they refused to make a doctor appointment to get a refill. Based on the information obtained, the allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

LIC9099 (FAS) - (06/04)

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