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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608482
Report Date: 05/18/2026
Date Signed: 05/18/2026 09:36:13 AM

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
01/09/2026 and conducted by Evaluator Luis DeLeon
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260109150138
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: 160DATE:
05/18/2026
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Director of Health Services Milca OsorioTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Staff inappropriately entered resident's room without permission
Staff inappropriately woke resident up
INVESTIGATION FINDINGS:
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*** This Licensing Report LIC-9099/LIC-9099C supersedes the LIC-9099/LIC-9099C LIC that was issued on 04/03/2026. The reason for the superseded licensing report is to separate the allegation into two allegations.***
Licensing Program Analysts (LPA) Luis De Leon conducted an unannounced subsequent complaint investigation visit for the allegations listed above to re-deliver report and findings for two separate allegations. LPA met with the Director of Health Services Milca Osorio and explained the reason for the visit. Administrator Liyon O'Quinn was not available during today's visit.

During the initial visit on 01/15/2026, Resident’s (R1's) file documents were reviewed. Copies of relevant documents were obtained. LPA conducted a physical plant inspection of residents’ bedrooms, dining room, and activity areas. Residents (R1-R10) and staff (S1-S9) were interviewed. During visit on 04/03/2026, LPA delivered finding for one allegation on complaint.
(Report continues on page LIC-9099C...)
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
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 3
Control Number 28-AS-20260109150138
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: 05/18/2026
NARRATIVE
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On today’s visit, LPA issued the superseded licensing report and re-delivered the licensing report. The findings will remain the same.
Regarding allegation: Staff inappropriately entered resident's room without permission.
It is alleged that staff entered resident’s room at night without resident’s invitation or permission. The investigation consisted of physical plant tours, interviews with staff, residents, and review of R1 facility file, including admission agreement, physicians report, needs and service plan, and facility staff training. The investigation revealed the following: On 11/15/2025, R1 pendant malfunctioned and staff took R1’s pendant for repair. S9 stated that S9 on 11/15/2025, around 10:30 PM, S9 was asked by facility shift nurse to return emergency call pendant to R1 at the beginning of S9’s shift. R1 is an independent resident, therefore, S9 does not normally enter R1’s room. S9 knocked on R1’s door two times to announce S9’s presence to R1, before entering R1’s room. S9 stated that S9 did not ring R1’s doorbell in case that R1 was already asleep. Upon S9 entering R1s room, R1 awoke and was startled and in distress after seeing an unknown staff member (S9), had entered R1’s room. R1 was aware that staff would return R1s pendant, however, R1 reported not being aware that staff would return R1s pendant on the same night the pendant was taken for repair. Interviews with residents revealed that nine (9) out of ten (10) residents stated that residents are not aware of staff entering residents’ rooms without permission. Six (6) out of ten (10) residents stated that staff sometimes wake residents at night to do welfare checks, but residents stated that residents understand the reason for staff doing welfare checks at night. Interviews with staff revealed that nine (9) out of nine (9) staff stated not to be aware of staff entering residents’ rooms without permission. Staff always knock on the door or ring the doorbell before entering residents’ rooms and staff announce themselves. At night, some residents may wake up during welfare checks, but staff try not to wake up residents. LPAs document review revealed that the facility has provided staff training on proper room entry on 11/17/2025, and 01/05/2026-01/12/2026. Based upon the investigation, client and staff interviews, document review, and LPA observations, there is no preponderance evidence to show that staff enters residents’ rooms without permission.
Regarding allegation: Staff inappropriately woke resident up.
It is alleged that staff entered residents’ room at night without the residents invitation or permission, causing the resident to wake up startled and become distressed when staff shone a light on the residents’ face. The investigation consisted of physical plant tours, interviews with staff, residents, and review of R1 facility file, including admission agreement, physicians report, needs and service plan, and facility staff training.
(Report continues on page LIC-9099C...)
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260109150138
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: 05/18/2026
NARRATIVE
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The investigation reveals the following: On 11/15/2025, R1 pendant malfunctioned and staff took R1’s pendant for repair. S9 stated that S9 that on 11/15/2025, around 10:30 PM, S9 was asked by facility nurse to return emergency call pendant to R1 at the beginning of S9’s shift. R1 is an independent resident, therefore, S9 does not normally enter R1’s room. S9 knocked on R1’s door two times to announce S9’s presence to R1, before entering R1’s room. S9 stated that S9 did not ring R1’s doorbell in case that R1 was already asleep. Upon S9 entering R1s room, R1 awoke and was startled and in distress after seeing an unknown staff member (S9) had entered R1’s room at night and shone a light towards R1’s face. S9 denies shining a flashlight onto R1’s face. S9 reported being unfamiliar with the layout of R1’s room, therefore, S9 used a personal flashlight to assist with walking into the R1s room. S9 reported being in possession of a flashlight while in R1s room and shone the light onto the ceiling of R1’s room. S9 was following staff’s orders to return R1’s pendant and did not mean to disturb R1 or cause R1 any distress. S9 stated that the facility did not provide S9 with a flashlight and used the flashlight to assist with navigating R1s room. Additionally, S1 stated that the flashlights are not issued to staff by the facility. Interviews with residents revealed that nine (9) out of ten (10) residents stated that residents are not aware of staff entering residents’ rooms without permission. Six (6) out of ten (10) residents stated that staff sometimes wake residents at night to do welfare checks, but residents stated that residents understand the reason for staff doing welfare checks at night. The same six residents stated that no staff have shone a light on their faces at night or startled residents in their sleep. Interviews with staff revealed that nine (9) out of nine (9) staff stated not to be aware of staff entering residents’ rooms without permission and shining a flashlight on residents’ faces. Staff always knock on the door or ring the doorbell before entering residents’ rooms and announce themselves. At night, some residents may wake up during welfare checks, but staff try not to startle residents. Eight (8) out of nine (9) staff denied using a flashlight during welfare checks. LPAs document review revealed that the facility has provided staff training on proper room entry on 11/17/2025, and 01/05/2026-01/12/2026. Based upon the investigation, client and staff interviews, document review, and LPA observations, there is no preponderance evidence to show that staff wakes residents up inappropriately in the performance of staff duties.

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 was held with Director of Health Services Milca Osorio. A copy of the report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3