197608482-5-18-2026-28-AS-DSIS-DUNPYR-20260602114422

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608482
Report Date: 05/18/2026
Date Signed: 05/18/2026 01:13:27 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
08/12/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250812093517

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: 16	DATE:	05/18/2026
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Milca Osorio - Health Services Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Unlawful eviction
Staff did not ensure and identify residents care needs were being met
Staff did not ensure a care plan meeting was conducted with resident
Staff did not ensure resident was free of retaliation after filing a complaint

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent complaint visit to investigate the above allegations. LPA met with Milca Osorio and explained the purpose of today's visit.

The investigation consisted of the following:
On 8/19/26 LPA E.Irra conducted initial visit and obtained a copy of the staff/resident rosters, reviewed Resident #1 (R1's) file, and conducted interviews with 3 Staff.
On 5/14/26 LPA Herrera conducted telephone interviews with R1 and 1 Staff (S2), obtained copies of R1’s Eviction Notice, Admission Agreement, yearly Needs and Service Plans from 2021-2025, Charting Notes, Court Documents and Seriff's Department Eviction Notice. LPA also obtained copies of Staff and Resident Rosters, all documents were received via email.
During todays visit 5/18/26, LPA interviewed 3 Staff (S3-5) and 10 Residents (R2-R11), obtained a copy of the Activity Schedule and delivered findings on the reported allegations. (Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
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)

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Control Number 28-AS-20250812093517

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: 05/18/2026

NARRATIVE

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The investigation revealed the following:
Allegation: Unlawful eviction
It is alleged that R1 was provided with an eviction notice that fails to provide a list of resources available to assist in providing alternative housing and care options. LPA interviewed R1 and they stated that they were not provided with resources for alternative housing and that the courts sided with facility on eviction. LPA was provided with a copy of Eviction Notice given to R1 dated 7/24/2025, the eviction notice documented reasons for eviction, the complaint contact numbers, and 3 different resources that could be used to find alternative housing. LPA obtained the Proceedings with Rulings on R1s eviction from the Los Angeles Superior Court dated May 1^st 2026, stating that the Motion to Set Aside/Vacate Judgment filed by R1 on 04/20/2026 is Denied. LPA obtained a copy of the Sheriff's Department Eviction notice dated 4/22/26 with a eviction date of May 7, 2026 at 8:30am. LPA interviewed 5 staff and each denied the allegation S1 and S2 stated that R1 had a series of disruptive and aggressive behaviors towards both staff and residents, R1 would refuse to be assisted and multiple residents and guests would complain of the aggressive behaviors, stating that they felt distress when R1 was present. LPA interviewed 11 Residents and 10 out of the 11 residents denied the allegation and stated they have never been issued an eviction notice or observed any other residents be unlawfully evicted.

Allegation: Staff did not ensure and identify residents care needs were being met.

It is alleged that staff do not assist R1 with their needs and do not provide activities that can assist with promoting R1’s quality of life. LPA interviewed R1 and they stated that they have a musical background and staff at the facility made no efforts to provide musical activities for R1. LPA obtained a copy of the facility’s Activity Calander and observed that every Tuesday there was sing along, Concerts on Wednesdays or Thursdays, Musical activities with Composers on Saturdays and Opera Singers on Sundays. LPA interviewed 5 staff and each denied the allegation, S1 and S2 stated that R1 never mentioned a musical interest and that the facility does provide activities that involve music. Interview with S5 revealed that although R1 stated that they enjoyed music, R1 never participated in any of the musical activities, even after reminders of the schedule were given and participation was encouraged. LPA interviewed 11 Residents and 10 out of 11 Residents denied the allegation and stated their needs are being met, the facility provides and promotes many activities that include music, poker, karaoke, holiday parties, literature and many more.

(Continued on LIC9099-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
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)

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Control Number 28-AS-20250812093517

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: 05/18/2026

NARRATIVE

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Allegation: Staff did not ensure a care plan meeting was conducted with resident.
It is alleged that there have been no meaningful efforts to create a care plan or have a meeting to assist R1 with their needs. LPA interviewed R1 and they stated that staff did not assist R1 with medical appointments or have meetings with R1 to create any care plans, R1 stated they are fairly independent and do not need assistance with ADL’s. LPA obtained copies of R1’s yearly assessments from 2021-2025, each assessment documented that R1 does not require assistance with Activities of Daily Living (ADL’s) such as grooming, bathing, toileting or assistance with transfers. LPA reviewed R1’s Charting Notes, there were notes stating that on 6/30/25, 7/11/25, and 10/7/25 staff provided assistance with scheduling visits for R1, however, R1 would refuse to attend. Charting Notes also detailed that R1 was on an unusual monitoring due to behavioral outbursts and aggression. LPA interviewed 5 staff and each denied the allegation and stated that R1 frequently refused any assistance and would close the door on staff or not let staff enter their room for regular cleaning. LPA interviewed 11 Residents and 10 out of 11 Residents denied the allegation and stated that staff constantly check in with them, offer support and although their care hasn’t changed since admission staff have met with them to ensure no additional care is needed.

Allegation: Staff did not ensure resident was free of retaliation after filing a complaint.
It is alleged that R1 was retaliated against as shortly after it was discovered that they filed a complaint they were issued an eviction notice. LPA interviewed R1 and they stated that they personally feel targeted and retaliated against by S1 and this stems from complaints that R1 has made verbally with S1 and complaints that S1 has discovered that R1 made with licensing or ombudsman. LPA interviewed 5 staff and each denied the allegation, S1 stated that they have never retaliated against R1 and that there is zero tolerance for residents utilizing their rights. LPA interviewed 11 Residents and 10 out of 11 Residents denied the allegation and stated they have never felt retaliated against by staff and have never seen other residents be retaliated against. Interviews with R9 and R10 revealed that they have complained about small things they were unhappy about, staff addressed their concerns and they never felt retaliated against by staff after voicing their opinions.

Based on statements and interviews conducted with staff/residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
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)

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