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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602267
Report Date: 03/30/2023
Date Signed: 03/30/2023 10:32:24 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2023 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230329120449
FACILITY NAME:ENSLOW MANORFACILITY NUMBER:
198602267
ADMINISTRATOR:KIFLEZGHIE, JOVONNEFACILITY TYPE:
735
ADDRESS:20015 ENSLOW DRIVETELEPHONE:
(310) 933-8710
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:4CENSUS: 4DATE:
03/30/2023
UNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Freda Duran, DSPTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility operating over capacity.
INVESTIGATION FINDINGS:
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On 03/30/2023, Licensing Program Analyst (LPA) Perry Scott conducted an initial complaint investigation to address the allegation listed above. LPA Scott met with (S1), DSP, and explained the purpose of this visit is to gather information for the complaint and deliver findings.

On 03/30/2023, the investigation consisted of the following:

LPA Scott conducted a tour of the facility grounds. Currently, the home is licensed to serve four (4); (2) ambulatory and (2) non-ambulatory clients. The facility consists of (3) client bedrooms (1) client bathroom and (1) staff bathroom, living room, kitchen, dining area, office, patio, garage used for storage and laundry area. LPA requested copies of client and staff rosters, Face Sheets, and ID/Emergency for each client.

The investigation revealed the following: Regarding the allegation: Facility operating over capacity.

Report conitinues on LIOC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20230329120449
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ENSLOW MANOR
FACILITY NUMBER: 198602267
VISIT DATE: 03/30/2023
NARRATIVE
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On 03/30/23, LPA interviewed Licensee, Jovonne Kiflezghie (S2) about the allegation that the facility is operating over capacity. The licensee denied the allegation and maintained that there are only four (4) clients in the facility. And that each client was sent by South Central Los Angeles Regional Center (SCLARC).

On 03/30/23, LPA interviewed S1 about the allegation and S1 also denied the allegation. S1 gave the LPA a tour of the facility and introduced the LPA to each client R1-R3 before they went off to their day program. However, R4 wasn’t feeling well and remained at the facility. LPA verified each client by the records the facility provided and toured the entire facility to verify that the facility was not operating over capacity. LPA found no such violation.

On 03/30/23, LPA confirmed with SCLARC that there are only four (4) clients placed at the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22.

An exit interview was conducted with S1, DSP and a copy of the report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2