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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608482
Report Date: 11/08/2022
Date Signed: 11/08/2022 04:58:31 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2022 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20221101142848
FACILITY NAME:KINGSLEY MANORFACILITY NUMBER:
197608482
ADMINISTRATOR:LIYON O'QUINNFACILITY TYPE:
740
ADDRESS:1055 NORTH KINGSLEY DRIVETELEPHONE:
(323) 661-1128
CITY:LOS ANGELESSTATE: CAZIP CODE:
90029
CAPACITY:299CENSUS: 191DATE:
11/08/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Liyon O'Quinn, Executive DirectorTIME COMPLETED:
05:00 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
Licensing Program Analyst (LPA) Tao conducted an unannounced initial 10-day complaint investigation regarding the above allegation. LPA discussed the purpose of the visit with Liyon O'Quinn, Executive Director.

The investigation consisted of the following:
LPA interviewed staff from staff#1 (S1) to staff #5 (S5); interviewed residents from resident #1 (R1) to resident #6 (R6); obtained resident roster and staff roster; reviewed facility file of resident#1, including a copy of the plan of operation - Eviction Process, three collection letters, 30-day eviction letter dated 10/5/22, face sheet, admission agreement, physician report, rent increase letter (dated 12/20/21), rental agreement, resident handbook and progress notes.

LPA conducted a physical plant tour during the visit.

(-Contined in LIC 9099C-)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
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-20221101142848
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: KINGSLEY MANOR
FACILITY NUMBER: 197608482
VISIT DATE: 11/08/2022
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 investigation revealed of the following:
Regarding the allegation of illegal eviction of resident, it was alleged that facility’s eviction procedure of evicting resident #1 (R1) was illegal. R1 was still residing at the facility during the interview. R1 was interviewed and stated the eviction procedure of resident#1 was illegal. LPA interviewed residents, five (5) out of six (6) residents could not corroborate the allegation. LPA interviewed staff and all staff denied the allegation. Based on file documents review, it appeared that R1 had been given three collection letters regarding the eviction procedure over the course of six months. The allegation was pertaining to the eviction notice given on 10/05/22, which the required elements, such as effective date and required written regulation statements were in compliance with the eviction procedure regulation. Staff interviews indicated that there has been probable cause to evict R1 over the course of one year. According to staff interviewed, R1 has not complied with facility’s request to pay the non-pay amount since November 2021. LPA determined that the eviction notices issued to Resident (R1) were lawful.

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 held with executive director, Liyon O'Quinn. A copy of the report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2