198602950-1-28-2021-28-AS-MVAO-BXVS43-20210203123206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 01/26/2021
Date Signed: 01/28/2021 03:49:32 PM

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
04/22/2020 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20200422122854

FACILITY NAME:	LAKEWOOD PARK MANOR		FACILITY NUMBER:	198602950
ADMINISTRATOR:	LISA PHAM		FACILITY TYPE:	740
ADDRESS:	12045 LAKEWOOD BLVD		TELEPHONE:	(562) 923-4417
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	160	CENSUS: 118	DATE:	01/26/2021
		UNANNOUNCED	TIME BEGAN:	04:07 PM
MET WITH:	Elizabeth Martinez - Assistant Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff are not managing residents' medications
Facility is not clean and sanitized
Residents' hygiene needs are not being met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Elizabeth Martinez, the assistant administrator.

The investigation consisted of the following: On 4/30/20 LPA Irra conducted a telephone interview with the Administrator. LPA requested copies of: Resident Roster, Staff rosters, list of Residents that manage their own medications, list of Residents that require assistance with activities of daily living, or daily notes, policy on how residents/next of kin/families have been informed about residents testing positive for COVID-19 and policy on maintenance/housekeeping including any logs/records that are maintained by this facility.
On 6/23/20 LPA Flores conducted a tour of the facility, observed kitchen, medication room, and 11 randomly pick resident rooms. On 6/29/20 LPA Flores conducted resident and staff interviews. On 10/15/20 LPA Flores interviewed 3 more residents. On 1/26/21 LPA Flores reviewed medication for resident over a video call with the assistance of assistant administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021

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-20200422122854

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: LAKEWOOD PARK MANOR	FACILITY NUMBER: 198602950
	VISIT DATE: 01/26/2021

NARRATIVE

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The investigation revealed the following: Regarding allegation; facility staff are not managing resident’s medications; it was alleged that facility has given full responsibility for taking daily meds as needed. Interviews with 9 out 9 residents revealed that medication is not kept in the resident’s room, and medication is provided by the nurse daily in their rooms as prescribed. 3 out 5 staff interviews stated that staff provides the medication to the residents in their rooms. During the facility's tour LPA did not observed medication in the random rooms that were visit. On 10/15/20 LPA Flores reviewed resident’s medication and observed medication for each resident matching the doctor's request. Based on LPA's observations, interviews, and file review conducted the preponderance of evidence the allegation is unsubstantiated.

Regarding allegation; facility is not clean and sanitized. It is alleged that facility had uncleaned rooms for over three days, and fears spread of corona virus inside facility. Interviews with 7 out of 9 residents revealed housekeeper cleans the room every day, in addition a few stated that staff do a deep cleaning of the rooms once a week. 1 out of 9 residents stated that staff clean their room twice a week. 1 out of 9 residents stated not to know or be aware of the cleaning schedule. Interviews with 7 out of 7 staff revealed that rooms are kept clean, 1 out of 7 staff interviewed stated that they do a deep cleaning of the rooms once a week. During a virtual tour of the facility LPA observed facility’s floors, hallways, kitchen, medication room, and residents’ room clean, no trash was observed in rooms and/or resident’s bathroom trash cans. LPA reviewed training provided on 3/20/20 to staff regarding properly cleaning and disinfecting of facility during COVID 19. Based on LPA's observations, interviews, and file review conducted the preponderance of evidence the allegation is unsubstantiated.

Regarding allegation; residents’ hygiene needs are not being met. It is alleged that residents have not been showered for over a week. Interviews with 7 out 9 residents revealed that facility assist the residents with showers at least twice a week as schedule by the facility. 1 out of 9 residents interviewed stated to receive assistant with showers every day. 1 out of 9 residents interviewed stated not to require assistance to shower. Interviews with 5 out of 7 staff revealed that caregivers assist residents with showers and that showers are schedule, twice a week for each resident, unless the resident request to shower daily. Based on LPA's observations, interviews, and file review conducted the preponderance of evidence the allegation is unsubstantiated.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021

LIC9099 (FAS) - (06/04)

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