198602950-9-29-2022-28-AS-RORN-CJWTXQ-20221005150730

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 09/29/2022
Date Signed: 09/29/2022 04:24:59 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
09/21/2022 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220921115307

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: 113	DATE:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Cynthia Flores, Asst. Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not communicating with resident
Staff do not provide adequate quantity of food
Staff provide poor quality of food
Staff do not provide snacks in between meals to residents
Staff do not dispense medications as prescribed

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegations. On today's visit, LPA met with Assistant Administrator Cynthia Flores, who assisted with the visit.

The investigation consisted of the following: Interview(s) with Assistant Administrator, and staff #1 -staff #4, interviews with resident #1- resident #8, review of resident medications, review of facility food supply, and facility menu.

Regarding the allegation that staff are not communicating with resident(s). Staff interviewed denied the allegation. Staff stated that staff communicate with residents, and they speak to them in a respectful, polite manner. Residents interviewed were unable to corroborate the allegation. 8 out of 8 residents stated that staff communicate with them in a polite manner.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 28-AS-20220921115307

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: 09/29/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation that staff do not provide an adequate quantity of food, and that the food quality is poor. Staff interviewed denied the allegation. Staff stated that the food served is sufficient and of good quality. Residents interviewed were unable to corroborate the allegation. 8 out of 8 residents interviewed stated that the food served is of sufficient quantity and quality. LPA Rea observed that the facility had a sufficient amount of food during today's visit, and it was of good quality.

Regarding the allegation that staff do not provide snacks in between meals to residents. Staff interviewed, denied the allegation. They stated that residents are able to have snacks in between meals. Staff stated that snacks are passed out in the kitchen to residents in between meals. Residents interviewed were unable to corroborate the allegation. 6 out of 8 residents interviewed stated that snacks are provided in between meals.

Regarding the allegation that staff do not dispense medications as prescribed. Staff interviewed denied the allegation. They stated that medication is dispensed according to doctors orders. Residents interviewed were unable to corroborate the allegation. 8 out 8 residents stated that they are given their medications as prescribed. LPA reviewed medication(s) on today's visit, and observed that medications appear to be dispensed as prescribed.

Based on LPA's observations and interviews, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Assistant Administrator, Cynthia Flores.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2