198602950-7-2-2021-28-AS-CYEE-C79T6Q-20210927142729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 07/02/2021
Date Signed: 07/02/2021 04:05:38 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
04/15/2021 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210415093023

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: 110	DATE:	07/02/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Cynthia Flores, assistant administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Financial abuse

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Spencer conducted a subsequent visit to conduct interviews and deliver the findings for the allegations listed above. LPA Spencer was met by assistant administrator Cynthia Flores and explained the purpose of today's visit.

The investigation consisted of the following: On 4/20/21, LPA Spencer conducted the initial investigation, took a tour of the physical plant, and conducted interviews with assistant administrator, staff #1 (S1), and residents #2-5 (R2-R5). During today's subsequent visit, LPA interviewed staff #2 (S2), residents #6-10 (R6-R10) and follow-up interviews with resident #1(R1) and the assistant administrator. LPA Spencer collected a copy of the staff roster, resident roster, and for 3 specified residents: rent payment receipts for January-April 2021, payment history log, and bank statements that were provided by R1.

***See LIC9099C for continuation of this narrative.

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: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

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-20210415093023

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: 07/02/2021

NARRATIVE

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The investigation revealed the following:

It was alleged that the facility was withdrawing unauthorized money from a resident's bank account. Staff interviewed denied the allegation and stated that residents are only charged a pre-authorized amount. The assistant administrator stated that residents can pay rent through either cash, check, or direct debit (automatically withdrawal), but the facility has no ability to see a resident's personal account balance. The assistant administrator stated that the facility maintains a payment history log and provides rent receipts to all residents. 9 out of 10 residents interviewed stated that they haven't had any extra withdrawals taken out by the facility. A review of the rent receipts, payment history log, and bank statements reveal that no additional money was taken by the facility aside from the regular board and care rate. In a follow-up interview with R1 on 7/2/21, the resident stated that the issue was resolved due to a mix-up with the social security office who withdrew funds from the account and stated that they were able to clear up the issue. The assistant administrator also stated in a follow-up interview that R1 and the assistant administrator discussed the issue with social security office and it was resolved.

Based upon 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.

An exit interview was conducted with assistant administrator and a copy of the report was provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

LIC9099 (FAS) - (06/04)

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