198602950-4-5-2022-28-AS-WSHO-CEB2J7-20220510172551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 04/05/2022
Date Signed: 04/05/2022 03:49:55 PM

Unsubstantiated

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
12/14/2021 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211214101414

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: 106	DATE:	04/05/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Assistant Administrator Cynthia Flores		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility is understaffed
Staff failed to meet residents' needs
Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Assistant Administrator Cynthia Flores and explained the reason for the visit.
The purpose of the visit is to investigate the above allegations.
At today's visit Resident's 1-8 were interviewed from 9:30 AM to 11:30 A.M.
LPA toured the facility and both elevators were operable and the facility was observed to be in good repair.
In regards to Facility is understaffed based on interviews conducted and information gathered residents interviewed stated that there is sufficient staff and they do a good job and help with any needs they may have.
Staff interviewed stated there are 4- AM staff, and 3-PM staff and the LIC 500 submitted at visit lists the same staff numbers. In addition the Administrator, Assistant Administrator and Resident Director are also available for AM and PM shifts.
Based on interviews, observations, 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 allegations are Unsubstantiated

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

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-20211214101414

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: 04/05/2022

NARRATIVE

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In regards to the allegation Staff failed to meet residents' needs, based on interviews conducted and information gathered residents interviewed stated that staff does a good job assisting with showers 2x a week.
Staff interviewed stated that showers are given 2x a week and if resident refuses they will notate it. Facility submitted to LPA documents of a shower log with resident names and when resident is given shower it is checked off.
Based on interviews, observations, 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 allegations are Unsubstantiated
In regards to the allegation facility is in disrepair, LPA toured facility on 12/23/2021 and today 4/5/2022 and both elevators were operable.
Previous complaint report 12/09/2021 28-AS-20211209101633 addressed the allegation elevator is in disrepair. Deficiency issued 12/15/2021. Deficiency cleared 12/15/2021.
Based on interviews with staff and residents there was no evidence revealed to support flooding having occurred in the facility.
Based on interviews, observations, 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 allegations are Unsubstantiated

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

LIC9099 (FAS) - (06/04)

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