197608482-5-12-2022-28-AS-MVAO-CHEQLZ-20220818121645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608482
Report Date: 05/12/2022
Date Signed: 05/12/2022 05:48:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/07/2022 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220307123621

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: 194	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Liyon O'Quinn		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff did not prevent resident from engaging in inappropriate behaviors
Staff failed to provide a safe environment for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Executive Director Liyon O'Quinn and explained the reason for the visit.

The investigation consisted of: On 3/14/22, LPA Gonzalez collected copies of Staff and Resident Rosters. LPA conducted an interview with Executive Director Liyon O'Quinn and Residents 1-6 (R1-6) and requested/ received pertinent documents related to complaint ninvestigation. On 5/12/22, LPA Gonzalez interviewed Exectutive Director Liyon O'Quinn, Divisioanl Vice President Randy Herzig, Staff 1-6 (S1-6), Residents 7-19 (R7-19) and conducted a tour of the facility with Executive Director Liyon O'Quinn. LPA toured the facility and observed residents in care in the following facility buildings: Main Building, Leitzell Hall, Administration Building, Margaret Hall, Holly Cottage (Library/Fitness Center), and the Dining hall. LPA also collected copies of Staff and Resident Rosters. LPA additionally interviewed R1's Family Member (R1 FM) and R6's FM (R6 FM).

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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-20220307123621

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: KINGSLEY MANOR	FACILITY NUMBER: 197608482
	VISIT DATE: 05/12/2022

NARRATIVE

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Investigation revealed the following: Regarding allegations, Staff did not prevent resident from engaging in inappropriate behaviors and Staff failed to provide a safe environment for residents in care, it is alleged that a facility resident has been physically violent, has broken decorative tables, doors and glass vases in the lobby. This resident also yells at residents and is always belligerent. Police have been called to the facility due to the resident's behavior. Facility residents are concerned and have expressed that they should not have to put up with this resident causing problems and trouble in the facility. Interview conducted Executive Director Liyon O'Quinn revealed that facility staff are doing everything in their control to prevent any facility resident from engaging in inappropriate behaviors and staff always ensure to provide a safe environment for all residents in care. Ms. O'Quinn stated that R4 has exhibited aggressive behaviors towards facility staff and facility residents. She stated that every time R4 is exhibiting inappropriate and/or aggressive behaviors staff will interfere and redirect the situation and also if the situation cannot be handled by facility staff by redirecting and attempting to calm the resident, the local police department has been called for assistance while keeping the residents safe and away from the ongoing situation. Executive Director stated that the facility has unsuccessfully attempted twice to request a 3 Day Eviction from Community Care Licensing (CCLD) due to R4's behaviors and the many concerns that she has received from a large number of facility residents expressing their concerns regarding R4 and their safety. Interview with Divisional Vice President Randy Herzig revealed that the facility's top priority is to always ensure all resident's safety while also ensuring that all resident's personal rights are respected. Mr. Herzig stated that the facility ensures that the facility environment is safe at all times. He stated that the staff will redirect any resident that is causing trouble and if the situation cannot be handled by facility staff then they will seek the assistance of the local police department. Interviews conducted with 6 out of 6 staff revealed that facility staff do prevent resident from engaging in inappropriate behaviors and the facility does provide a safe environment for residents in care. 4 out of 6 staff stated that R4 has been repeatedly redirected but there have been times when the situation has escalated to the point that the police has had to be called. 6 out of 6 staff stated that their top priority is to keep the residents safe while still ensuring to properly redirect the aggressor. 6 out of 6 staff stated that at times they will just keep the residents away from the situation until the situation is de-escalated. Interviews conducted with 14 out of 19 residents revealed that they are satisfied with the services and care that they receive at the facility and stated that their concerns are not regarding the facility or the facility staff but about R4. 15 out of 19 residents stated that they feel the facility is safe. They also stated that staff do prevent R4 from engaging in inappropriate behaviors when the resident is having an

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220307123621

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: KINGSLEY MANOR	FACILITY NUMBER: 197608482
	VISIT DATE: 05/12/2022

NARRATIVE

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active behavior. They stated that staff make sure that they are safe and are kept out of harms way. 15 out of 19 residents clarified that they are not happy that R4 is still living at the facility and stated that the facility is their home and if R4 is unable to control their behaviors they should not be living in the facility. Interviews conducted with R1 FM and R6 FM revealed that their concerns are not against the facility and/ or the staff but their concerns are regarding R4's behavior which is causing fear among the residents. R1 FM and R6 FM stated that the staff immediately prevent R4 from engaging in inappropriate behaviors when they witness such situations. They also stated that they have observed how aggressive R4 can be with staff while they are trying to redirect the resident. R1 FM and R6 FM stated that the facility does provide a safe environment for the residents in care and if that was not the case they would place their loved ones somewhere else. They expressed their concerns regarding the ongoing situations with R4 and feel that it is not fair for the residents to experience such outbursts or for residents to have to actively try to avoid run ins with this resident as the facility is their home and the residents have already had a tough last couple of years dealing with the lockdowns that were brought on by the COVID-19 pandemic. LPA toured the facility and observed residents engaging in activities throughout the facility. Residents appeared to be safe and LPA did not observe any safety concerns during the visits conducted on 3/14/22 or 5/12/22. LPA observed facility staff tending to residents in the dining room, library and in the main building. Based on interviews conducted with facility staff, facility residents, resident's family members, and LPA observations, 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. A copy of the report was provided to Executive Director Liyon O'Quinn.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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