198320092-5-29-2026-11-AS-EMAZ-DV5RG2-20260617130001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320092
Report Date: 05/29/2026
Date Signed: 05/29/2026 04:59:17 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
05/24/2026 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260524160359

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: 6	DATE:	05/29/2026
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	KIM MANOR		TIME COMPLETED:	02:52 PM

ALLEGATION(S):

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Staff are not allowing resident to return to the facility.

INVESTIGATION FINDINGS:

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On May 29, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Ernand Dabuet, conducted an initial unannounced complaint visit. Kim Manor administrator, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegation mentioned above.

The investigation included interviews, inspection of the facility, and a collection of documents. The Department reviewed the Identification and Emergency Information LIC 601 (dated 10/24/25), Physicians Report LIC602 (dated 10/16/25), Admission Policy and Agreement (dated 10/24/25) Personal Rights LIC 613 (dated 10/24/25) and Medical Health Intake Assessment (dated 10/27/25), Unusual Incident Reports LIC 624 (dated 05/12/26 and 05/19/26) and email communications between Staff #1 and Witness #1 (dated 05/19/26 and 05/26/26). Interviews with Staff #1 and Witness #1.

(Evaluation Report continues on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

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-20260524160359

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: 05/29/2026

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff are not allowing resident to return to the facility.

It is alleged that staff are preventing Client #1 (C1) from returning to the facility. (C1) has completed treatment at Harbor-UCLA Medical Center. The administrator has been contacted several times regarding (C1's) discharge but has redirected these inquiries to the responsible party. An eviction notice was issued on May 8, 2026, which prevents (C1) from returning to the facility, and the 30-day notice period has not yet expired. No further details regarding this matter are currently available.

On May 29, 2026, between 9:45 AM and 11:30 AM, the Department interviewed the following staff identified as Staff #1 (S1). ((S1) stated that this claim is not true and can be misleading. (S1) reported that (C1) is independent and self-admitted for medical treatment on May 19, 2026, at Harbor UCLA Medical Center. (S1) asserted that Client #1 (C1) still lives at the facility, no 30-Day Eviction Notice was given to (C1), and (C1's) belongings have not been taken from the facility. (S1) explained that (C1's) responsible party, Witness #1 (W1), is the one who makes decisions about (C1's) who has control of (C1’s) living situation. (S1) mentioned that emails were sent between May 19 and May 26, 2026, to (W1), who have decided that (C1) will not return to Lifestyle Board and Care. In the email communication, (S1) was given directive to pack (C1's) things and store them until (W1) can find a new place for (C1).

On May 29, 2026, between 10:55 AM and 11:10 AM, the Department interviewed the following witness identified as Witness #1 (W1). (W1) has been identified as the person responsible for (C1) and has the authority to make decisions regarding where (C1) resides. (W1) confirmed that the Lifestyle Board and Care has not given 30-Day Eviction notice. Instead, (W1) believes that the current facility cannot meet (C1's) needs, and (W1) is actively seeking a more suitable living option for (C1) with the assistance of Harbor UCLA Medical Center. (W1) reiterate that staff have not refused (C1) to return to the facility. The hospital discharge has been delayed because suitable alternative housing for (C1) is currently unavailable.

The Department reviewed Client #1 (C1’s) Identification and Emergency Information LIC 601 (dated 10/24/25), Physicians Report LIC 602A (dated 10/16/25), Admission Policy and Agreement (dated 10/24/25) Personal Rights LIC 613 (dated 10/24/25) and Medical Health Intake Assessment (dated 10/27/25). Further review of Unusual Incident Reports LIC 624 (dated 05/12/26 and 05/19/26), Register of Facility Clients LIC 9020 (dated 04/30/26) and email communications between Staff #1 and Witness #1 (dated 05/19/26 and 05/26/26).

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260524160359

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: 05/29/2026

NARRATIVE

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The Department confirmed with the El Segundo Community Care Licensing Adult and Senior Care that no eviction notice from Lifestyle Board and Care has been issued or received.

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

Based on the information collected 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.

No deficiencies were cited.

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: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

LIC9099 (FAS) - (06/04)

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