197608482-5-15-2026-28-AS-FFIS-DVHV8R-20260629161311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608482
Report Date: 05/15/2026
Date Signed: 05/15/2026 12:10:43 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
04/02/2026 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260402090409

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: 160	DATE:	05/15/2026
		UNANNOUNCED	TIME BEGAN:	08:51 AM
MET WITH:	Liyon O'Quinn		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff do not keep facility free from bedbugs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 05/15/2026 regarding the above allegation. On 04/03/2026, LPA De Leon conducted an initial complaint investigation, and a need for further investigation was documented. During today’s visit LPA Ramirez was greeted by Liyon O'Quinn and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 5 interviews (S1 – S5), Resident#1-6 interviews (R1 – R6), Pest Control Technician interview (W1), Pest Control Service Reports from October 2025 through May 2026, and physical plant tour.

SEE 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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-20260402090409

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: 05/15/2026

NARRATIVE

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The investigation revealed the following: regarding the allegation “Staff do not keep facility free from bed bugs.” It is alleged that R1 and other residents’ bedrooms have bed bugs and staff do not keep the facility free from bed bugs. Five (5) out of the five (5) staff interviewed denied this allegation. Staff interviews revealed that if residents suspect they may have bed bugs in their room, the facility contacts their contracted Pest Control company to come out and treat the resident’s room immediately. Staff interviews revealed that when bed bugs have been discovered in a resident’s room, staff instruct the resident to discard items that cannot be treated, however some residents refuse to discard their items. Interview with W1 revealed that they are the facility pest control technician and conduct pest control services monthly and as needed for immediate concerns. W1 revealed that the facility has followed all recommendations to eliminate bed bugs in resident rooms. W1 revealed that after an initial treatment for bed bugs, the resident room is then re-treated again in 2 to 3 weeks. W1 revealed that they have witnessed residents’ refusal to dispose of certain items that they have seen infested with bed bugs and the bed bugs return even after bed bug treatment was provided to the room. Two (2) out of nine (9) residents interviewed corroborated this allegation. Resident interviews revealed that the facility does provide treatment for bed bugs, and they have seen pest control technicians at the facility at least once a month. R8 revealed they currently have bed bugs in their room and staff are not treating the infestation. LPA Ramirez and S5 toured R8’s room and did not observe bed bugs in R8’s mattress or bedroom furniture. S5 revealed that R8 has never mentioned they have bed bugs or that R9 has seen bed bugs in their room. R9 revealed they had bed bugs twice in 8 months but that recently their room had been treated and no longer have bed bugs. LPA toured R9’s bedroom and did not observe bed bugs in R9’s mattress or in nearby furniture. Record review of pest control services report revealed that on 05/11/2026, no live bed bugs were observed in R9’s room and pest control recommended staff monitor R9’s room. 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 allegation is UNSUBSTANTIATED.

Exit interview conduct. A copy of this report was provided. No deficiencies were cited during this investigation.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

LIC9099 (FAS) - (06/04)

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