197608482-8-25-2026-28-AS-LHIS-DXLKHE-20260904075501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608482
Report Date: 08/25/2026
Date Signed: 08/25/2026 03:00:23 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
08/18/2026 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260818151148

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: 150	DATE:	08/25/2026
		UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	Liyon O'Quinn, Administrator		TIME COMPLETED:	03:08 PM

ALLEGATION(S):

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Staff do not serve residents food of good quality
Staff do not ensure that residents' dietary needs are met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alberto Lopez made initial unannounced visit to investigate the above allegations. LPA met with Chia Demurjan, Interim Executive Director and Liyon O'Quinn, Administrator. LPA discussed the purpose of the visit.

The investigation consisted of LPA obtaining and reviewing staff and resident rosters, R1 physicians report, facility menus, interviewed ten (11) residents (R#1 – R#11), four (4) staff (S#1- S#4), and took tour of dining hall during the lunch hour to observe the food served.

The investigation revealed regarding allegation: Staff do not serve residents food of good quality. It is alleged that the food is not of good quality and consists of unhealthy food for resident.
LPA interviewed ten (11) residents and nine (9) of ten (11) residents could corroborate the allegation. LPA interviewed four (4) staff, and all four (4) staff denied the allegation.
(continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026

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-20260818151148

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: 08/25/2026

NARRATIVE

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(continued from 9099)

Administrator, (S1) stated that it is a personal taste preference of R1 and that the food served is nutritious and meets department requirements. S1 also stated that there are choices and that R1 eats at the facility every day. LPA toured the dining hall at lunch time and observed the food to appear fresh, varied and nutritious. Facility also has always available menu for residents that prefer to choose an alternative that is not on the daily menu. There is insufficient evidence to substantiate this allegation.

Allegation: Staff do not ensure that residents' dietary needs are met. It is alleged that facility serves shrimp almost everyday and R1 cannot eat it due to high cholesterol content.

LPA interviewed ten (11) residents and nine (10) of ten (11) residents could corroborate the allegation. LPA interviewed four (4) staff, and all four (4) staff denied the allegation. S1 stated that shrimp is not served every day and that R1 can make choice to have something else. LPA reviewed the menu for this week 08/24/2026, and shrimp was on the menu once for lunch and once for dinner on separate days. Menu shows other items available if resident does not want shrimp. LPA observed menu to have at least two main course items every day to choose for lunch and dinner every day. Facility also has always available menu for residents that prefer to choose an alternative that is not on the daily menu. R1 does not have doctor’s order for special diet on file. There is insufficient evidence to substantiate this allegation.

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 the Administrator. A copy of this report, along with the appeal rights, was provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026

LIC9099 (FAS) - (06/04)

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