197608482-4-14-2023-28-AS-TVAO-CSESH8-20230602135303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608482
Report Date: 04/14/2023
Date Signed: 04/14/2023 03:49:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
04/10/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230410152711

FACILITY NAME:	KINGSLEY MANOR		FACILITY NUMBER:	197608482
ADMINISTRATOR:	LIYON O'QUINN		FACILITY TYPE:	740
ADDRESS:	1055 NORTH KINGSLEY DRIVE		TELEPHONE:	(323) 661-1128
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90029
CAPACITY:	299	CENSUS: 178	DATE:	04/14/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Liyon O'Quinn, Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff spoke inappropriately to resident in care.
Staff failed to treat resident with dignity and respect.
Staff failed to provide a comfortable environment.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA arrived unannounced and met with Administrator, Liyon O'Quinn. The purpose for the visit was explained.

LPA obtained copies of the Staff and Resident rosters. Interviews were held with the Administrator, 6 Staff, and 12 Residents.

The investigation revealed the following:
Allegation - Staff spoke inappropriately to resident in care. It is alleged that Staff told resident not to come to the dining room until hair is combed. Administrator and Staff stated they do not speak inappropriately to residents. Staff acknowledged that they would let residents know politely and privately when they are not dressed or groomed presentably when coming down to the dining area. They speak to the residents in private so others do not hear.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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 28-AS-20230410152711

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: KINGSLEY MANOR	FACILITY NUMBER: 197608482
	VISIT DATE: 04/14/2023

NARRATIVE

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They are careful with the choice and delivery of words to residents. They are trained to be professional and calm when talking to them. They stated that they do not want residents to misinterpret and think differently. LPA interviewed 12 residents during the visit. 11 out of 12 residents stated the staff are respectful and have not made any comments in which they felt were inappropriate.

Allegation - Staff failed to treat resident with dignity and respect. Administrator and Staff said they treat residents with dignity and respect. They are aware of their individual differences and accommodate them as much as possible. They treat them fairly and never put any one down or embarrass them in any way. 11 out of the 12 residents interviewed stated that the facility staff treat them with dignity and respect. They have not encountered any staff mistreating any residents or saying things that made them feel uncomfortable.

Allegation - Staff failed to provide a comfortable environment. Administrator and Staff stated they make sure residents are safe and comfortable. They are accommodating and will provide extra support when needed. If residents need anything, staff will assist and if they have concerns, management will address them right away. Staff indicated that they do round checks to ensure residents' needs are met and that they are comfortable. 10 out of 12 residents stated they feel safe and comfortable residing at this facility. The staff will assist right away if they need something and they receive good services while living here.

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 Administrator O'Quinn. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC9099 (FAS) - (06/04)

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