198602950-3-16-2021-28-AS-MVAO-BZMR22-20210331123737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 03/16/2021
Date Signed: 03/16/2021 01:33:10 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
08/13/2020 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200813120523

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: 115	DATE:	03/16/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Elizabeth Martinez, assistant administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff yelled at resident.
Staff threatened resident.
Staff did not treat resident with respect.
Staff did not provide transportation for resident.
Staff did not seek medical attention for resident.
Staff did not provide assistance to resident after resident used emergency pull switch.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicole Spencer 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 facility assistant administrator.

During the initial visit on 8/19/20, LPA Spencer conducted telephone interviews with assistant administrator Cynthia Flores and staff #1, and conducted a Facetime video call which consisted of a review of the physical plant including the front entrance, dining room, hallways, and the emergency pull switch in a resident room. The LPA requested and reviewed copies of Staff Roster (LIC 500), Resident roster, COVID-19 Isolation Plan/Resident policy, Admissions Agreement, Staff Contact Number list, training log for most recent Personal Rights training conducted, and the Emergency Pull switch log for the week of 8/9-8/15/20. During the course of the investigation, LPA Spencer conducted telephone interviews with staff #2, administrator Lisa Pham, and residents #1-11. *See continuation on LIC9099.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021

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-20200813120523

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: 03/16/2021

NARRATIVE

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A total of 4 staff and 11 residents were interviewed. Resident #9 declined to be interviewed, and resident #11 could not be interviewed because she passed away, so a total of 9 resident interviews were conducted.
Staff yelled at resident: During the observation, LPA observed staff speaking calmly to residents. A review of the training logs revealed that staff attended a Personal Rights training titled “Personal Rights: Redirecting during COVID Pandemic” on 3/20/20. All 4 staff interviewed denied yelling at a resident to go in their room and did not have knowledge of other staff yelling at a resident. The administrator stated that during the incident in question, the staff calmly told Resident 1 (R1) to go back in the room because there was a suspected COVID-19 positive resident and they were advising residents to stay in their room. 7 out of 9 residents interviewed stated that staff do not yell and they have not heard staff yelling at other residents.
Staff threatened resident: All 4 staff denied threatening to evict a resident for being in the hallway. Concerning the incident in question, the administrator stated that she told R1 that she would tell their responsible party if they did not comply with staying in the room and keeping social distancing. However, she denied that she threatened the resident with an eviction. 7 out of 9 residents interviewed stated that staff do not threaten them and have not heard of staff threatening other residents.
Staff did not treat resident with respect: During the observation, LPA observed staff knocking on resident doors before entering. All staff said that they treat residents with respect and do not enter the resident's room without permission. Regarding the incident in question, the administrator stated that she spoke with R1 near his door in the hallway and did not enter his room without permission. 7 out of 9 residents stated that the staff treat all residents with respect. A review of the training log revealed that staff attended a Personal Rights training on 3/20/20.
Staff did not provide transportation for resident: During this investigation, LPA Spencer reviewed the admissions agreement and transportation policy. A review of the transportation policy revealed that a transport van is available but medical appointments have priority. If facility transportation is not available, the facility will arrange for alternative transportation if the usual transportation is not available. The administrator stated that due to COVID-19, facility transportation is placed on hold and they use alternate transportation such as Dail-a-Ride, Uber, or Lyft. All 4 staff stated that transportation is usually scheduled in advanced, and that most residents use transportation covered through their insurance. For last minute transportation needs, the staff stated that they will assist with transportation through Dial-a-ride, Uber, or Lyft. 7 out of 9 residents stated that they have not had trouble or heard of other residents having trouble getting transportation arranged.
***Continued on LIC 9099C

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200813120523

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: 03/16/2021

NARRATIVE

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Staff did not seek medical attention for resident: The administrator stated that all residents are provided medical attention and denied that residents did not receive prompt medical attention. The other staff also stated that medical attention is provided to all residents. Staff 1 (S1) stated that when residents have ongoing appointments such as dialysis, the facility will ensure that resident appointments are scheduled in advance. For emergency medical treatment, they will call paramedics or arrange for them to go to urgent care. 8 out of 9 residents stated that staff seek medical attention when needed and they were not aware of any resident being denied medical attention.
Staff did not provide assistance to resident after resident used emergency pull switch: During this investigation, LPA Spencer reviewed the emergency pull switch logs for 8/9-8/15/20 and showed that all emergency pull switch requests were responded to. 3 staff denied the allegation that staff did not provide assistance to residents after they used the emergency pull switch and 1 staff was unsure and did not have information about this. Out of the 9 residents interviewed, 7 stated that staff usually respond quickly, and 2 stated that they do not use the switch at all.

Based upon physical plant observation, interviews conducted, and documents reviewed, the findings indicate although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated.

A telephonic exit interview was conducted with assistant Administrator Elizabeth Martinez. A hard copy of the report was emailed. Staff was instructed to sign the LIC 9099 reports and return to LPA.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021

LIC9099 (FAS) - (06/04)

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