198602950-12-6-2021-28-AS-MVAO-CADTA8-20220105133308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 12/06/2021
Date Signed: 12/06/2021 05:01:33 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
07/29/2021 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210729115524

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: 108	DATE:	12/06/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Cynthia Flores, assistant administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff refused to provide resident's medical records.
Resident was provided the wrong medication.
Staff refused to provide necessary medical treatment.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Nicole Spencer and Joseph Hanna conducted a subsequent complaint investigation for the allegations listed above. LPA Spencer met with assistant administrator Cynthia Flores and explained the purpose of today's visit.

The investigation consisted of the following: During the initial visit on 8/3/21, LPA Spencer conducted interviews with the assistant administrator, staff #1 (S1), and resident #1 (R1). LPA Spencer obtained a copy of the staff roster, resident roster, resident face sheet, physician's report, and physician's orders. During today's visit on 12/6/21, LPA 's interviewed resident #2-11 (R2-R11), staff #2 (S2), R1's physician (P1), and R1's home health agency worker (HH1).

Regarding the allegation, "staff refused to provide resident's medical record," it was alleged that the facility refused to provide a resident with their medical records upon request. ***See LIC9099C for continuation of the 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: 12/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021

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-20210729115524

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: 12/06/2021

NARRATIVE

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Interviews with residents revealed: One (1) out of eleven (11) residents stated that they requested medical records from the facility but have not received it. This resident stated that they wanted medical records regarding an injury that took place in the facility. The assistant administrator stated that there are no records of such injury and that the facility can only provide the records that they have on file. Ten (10) out of eleven (11) residents interviewed stated that they have not had any trouble receiving their medical records upon request and have not heard of any other residents having this issue. All others interviewed stated that they were not aware of this issue.

Regarding the allegation, "Resident was provided the wrong medication," all staff interviewed denied the allegation and stated that residents are only given medications prescribed by the resident's physician. One (1) out of eleven (11) residents interviewed stated that they were given the wrong medication, "Seroquel." A review of the resident's current physician's orders shows that medication "Seroquel" is not listed. A review of the resident's physician report reveals other medications are provided but "Seroquel" is not listed. Ten (10) out of eleven (11) residents interviewed stated that they have never been provided the wrong medication and have not heard of other residents with this issue. R1's physician stated that he has no information regarding this.

Regarding the allegation, "Staff refused to provide necessary medical treatment," it was alleged that staff refused to treat a resident's toe blister. All staff interviewed denied the allegation and stated that all resident's receive necessary medical treatment. Ten (10) out of eleven (11) residents stated that the facility provides necessary medical treatment, while one (1) out of eleven (11) residents interviewed stated that they did not receive proper treatment for their toe. Staff interviewed stated that home health was treating the resident's toe but the resident was not complying with home health's recommended treatment plan. The home health agency worker (HH1) interviewed stated that the resident had a callous wound that was treated by home health and it was healed prior to discontinuing the treatment. HH1 noted that the resident was non-compliant with treatment.

Based on interviews and records reviewed, it is determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with the assistant administrator Cynthia Flores and copy of 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: 12/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021

LIC9099 (FAS) - (06/04)

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