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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608482
Report Date: 08/28/2025
Date Signed: 08/28/2025 12:46:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
06/18/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250618085712
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: 177DATE:
08/28/2025
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Liyon O'Quinn, Executive DirectorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff are not preventing resident from engaging in inappropriate behavior towards other residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted a subsequent unannounced complaint visit at the facility and met with the Executive Director, Liyon O'Quinn to discuss the purpose for today's visit. The purpose of the visit is to investigate the above allegation.

On 06/19/2025, the initial investigation visit was conducted. The investigation consisted of the following:

Investigation consisted of the following: LPA requested a copy of staff and resident rosters. LPA also requested copies from Resident#1 (R1) file such as: Face Sheet, Physician’s Report, Admissions Agreement, Progress Notes, Assisted Living Waiver info, Incident Reports, Needs and Services Plan, Eviction Notice documents and court documents. LPA also received Face Sheets from Resident#5 (R5) to Resident#7 (R7) and former Resident #1 (FR1’s) files. LPA interviewed R1 to Resident #4 (R4), the Executive Director, and Staff #1 (S1) to Staff #5 (S5).
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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 28-AS-20250618085712
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: KINGSLEY MANOR
FACILITY NUMBER: 197608482
VISIT DATE: 08/28/2025
NARRATIVE
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On 08/26/2025, LPA Konishi spoke with the Executive Director over the phone. LPA obtained ongoing staff training on Preventing and Responding to Abuse and Residents’ Personal Rights by email.

During today's visit, LPA obtained the following documents: staff and client rosters. LPA interviewed Resident #5 (R5) to Resident #18 (R18).

The investigation revealed the following: In regards to the allegation, “Staff are not preventing resident from engaging in inappropriate behavior towards other residents in care.” It is alleged Resident #5 (R5) was pushed by Resident #1 (R1) in the dining hall since R5 was sitting at that R1’s preferred seat. It is also alleged that R1 was becoming more aggressive and yelled at other residents. It is alleged that R1 hit his hand on the table and threw a soda at another resident. LPA interviewed six (6) out of six (6) staff that all denied the allegation and stated the staff acted appropriately by immediately intervening, separating, and re-directing R1 and R5. Six (6) out of six (6) staff interviewed stated that R1 did not throw a soda can at another resident but slammed the soda can on the table. LPA interviewed R1 and R1 denied the allegation by stating not hurting R5 or anyone at the dining hall. R1 also stated that R1 did not throw any soda or object at R5. However, R1 stated that R1 was upset because R5 was sitting at R1's preferred seat and that the staff intervened and tried to de-escalate the situation by speaking to him and R5. LPA interviewed R5 and R5 denied the allegation stating that R1 did not yell at R5 or throw any soda or an object at R5 at the dining hall. LPA interviewed 18 out of 18 residents that denied the allegation and stated that the staff intervene whenever residents are involved in a physical or verbal altercation. LPA interviewed three (3) out of 18 residents that stated witnessing R1 and R5 involved in the verbal altercation in which staff immediately intervened to de-escalate the situation by separating the residents. Three (3) of the 18 residents interviewed stated witnessing the incident and no soda or object was thrown by R1 to another resident. LPA reviewed ongoing staff training on Preventing and Responding to Abuse and Residents’ Personal Rights in file. There was insufficient evidence to corroborate with the allegations.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided to the Executive Director, Liyon O'Quinn.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
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