198320092-2-18-2026-11-AS-JHAD-DRQ2AH-20260227161331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320092
Report Date: 02/18/2026
Date Signed: 02/18/2026 09:08:21 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/12/2026 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260212155341

FACILITY NAME:	LIFESTYLE BOARD AND CARE		FACILITY NUMBER:	198320092
ADMINISTRATOR:	MANOR, KIM		FACILITY TYPE:	735
ADDRESS:	149 EAST 235TH STREET		TELEPHONE:	(562) 743-1037
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	6	CENSUS: 7	DATE:	02/18/2026
		UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	Susan Etheridge		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff hit client.

INVESTIGATION FINDINGS:

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On February 18, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced complaint visit. Susan Ethridge caregiver greeted the LPA. Ethridge contacted Kiim Manor administrator by telephone and explained that the purpose of the visit is to investigate the allegation mentioned above.

The investigation included a collection of records, interviews and tour of the facility. The Department collected service records for Client #1 (C1), Physician's Report LIC 624 (dated 09/25/25), ID and Emergency Informaition LIC 601 (dated 10/23/25), Appraisal/Needs and Service Plan LIC 625 (dated 10/23/25), Functional Capability Assessment LIC 9172 (dated 09/25/25) Medication Administration Record (dated 02/01/26 - 02/18/26), Unusual Incident Report LIC 624 (dated 02/13/25), and other documents pertinent or associated with this complaint.

(Evaluation Report contnues LIC 9099-c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026

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 11-AS-20260212155341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: LIFESTYLE BOARD AND CARE	FACILITY NUMBER: 198320092
	VISIT DATE: 02/18/2026

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff hit resident.

The complaint alleges that Staff #1 (S1) physically struck Client #1 (C1). It has been reported that (C1) is fearful of (S1) due to previous interactions. Reports indicate that (S1) engaged in inappropriate behavior by intentionally hitting (C1) to prevent (C1) from participating in an outdoor activity. On February 12, 2026, (C1) once again expressed fear of (S1) following an incident that prompted law enforcement to investigate their interaction. No further information has been provided regarding this situation.

On February 18, 2026, between 10:30 AM and 11:45 AM, the Department interviewed client members identified as Client #1 through Client#5 (C1-C5). Five (5) out of five (5) clients could not validate this claim. (C1) clarified that there had been no instances of physical assault by any staff member and concluded the interview, preferring to refrain from sharing additional details at that time. Interviews with (C2-C5) indicated that they have never seen or heard of any physical or verbal assault involving (S1) and (C1). (C2-C5) commend the staff for their professionalism and courteous behavior towards clients. (C6-C7) was unavailable for an interview.

On February 18, 2026, between 09:30 AM and 11:50 AM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members could not corroborate this claim involving (S1) and (C1). All verified that no staff members acted inappropriately, either verbally or physically, towards clients. (S1) claimed that any incidents involving physical harm to (C1) are fabricated. On February 12, 2026, (S1) confirmed an incident involving (C1). A law enforcement investigation took place, with (C2) as a witness. Law Enforcement found that there was no abuse of a dependent adult.

On February 18, 2026, between 10:53 AM and 11:43 AM, the Department attempted to interview the witness identified as Witness #1 (W1) by telephone. However, the calls went unanswered, and no responses were received.

During the investigation on February 18, 2026, the Department observed staff members interacting with clients and noted that their conduct was appropriate. The Department found that the facility upholds the rights of its clients. Posters detailing Resident Rights, Personal Rights, were displayed prominently throughout the facility.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260212155341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: LIFESTYLE BOARD AND CARE	FACILITY NUMBER: 198320092
	VISIT DATE: 02/18/2026

NARRATIVE

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The Department reviewed Client #1 (C1’s) Physician's Report LIC 624 (dated 09/25/25), ID and Emergency Information LIC 601 (dated 10/23/25), Appraisal/Needs and Service Plan LIC 625 (dated 10/23/25), Functional Capability Assessment LIC 9172 (dated 09/25/25) Medication Administration Record (dated 02/01/26-02/18/26),) Unusual Incident Report LIC 624 (dated 02/13/25) revealed that (C1’s) medical diagnosis contributes to (C1’s) line of thinking/belief system. A further review of Carson Sheriff’s Police Report #0264921624461 concluded that there was no evidence of abuse against dependent adults.

Based on the information gathered, there is not enough evidence to support the allegation mentioned above.

Based on the information gathered from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

An exit interview was conducted with Kim Manor, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026

LIC9099 (FAS) - (06/04)

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