198602950-9-1-2022-28-AS-WSHO-CV6M9J-20230829092450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 09/01/2022
Date Signed: 09/01/2022 03:05:15 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
08/22/2022 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20220822142735

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: 112	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Assistant Administrator Cynthia Flores and Administrator Lisa Pham		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff failed to treat residents with dignity and respect
Staff failed to meet resident’s diapering needs
Staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegations listed above. LPA met with Assistant Administrator, Cynthia Flores and Administrator Lisa Pham and explained the reason for the visit.

The investigation consisted of the following: LPA Margaryan conducted interviews with Administrator, Assistant Administrator, Staff 1 to Staff 4 (S1 to S4) and Resident 1 to Resident 5 (R1 to R5). The following documents were requested: staff and residents roster, Staff schedule (with staff names) for the month of August, copies of relevant documents from R#1 file were provided. S1 and R1 were interviewed over the phone. S1 was off and R1 was out of the facility at the time of visit.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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-20220822142735

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: 09/01/2022

NARRATIVE

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Regarding allegations: Staff failed to treat residents with dignity and respect and Staff handled resident in a rough manner.

It was alleged that one resident (name unknown) was confused and kept getting up in his / her wheelchair. S1 grabbed his/her shoulders in a rough manner and made him /her sit in his chair and told him, “You have to do what I am asking you to do” and then took the resident away.,and S1 is disrespectful to R1 and other residents. and for R1 call to get assistance to change the diaper S1 told R1 in a rough manner “I said I would be back”. R1 not feels safe around S1.

5 out of 5 residents said that staff has never handled them in a rough manner and failed to treat residents with dignity. 4 of 5 residents said they have never witnessed staff handling other residents in a rough manner. They stated that staff nice and respectful. R1 stated that S1 treat him /her with dignity and respect. During interviews with Administrator , Assistant Administrator and staff, they advised that they have never handled residents in a rough manner and failed to treat residents with dignity and respect. Interviewed Administrator advised that he/she has never witnessed or received any complaints from residents that staff has handled them in a rough manner or failed to treat residents with dignity and respect. Never heard that R1 complains that R1 not feels safe around S1. S1 was interviewed over the phone and S1 denied that he/she failed to treat residents with dignity and respect and handled R1 or other resident in a rough manner. S1 stated he/she never grabbed any resident shoulders and made him/her to sit in the chair in a rough manner. S1 denied that he/she handled R1 in a rough manner during the assistance to change the diaper. S1 stated that R1 prefer to get an assistance for diaper change from woman staff. S1 never assist R1 for diaper change. R1 stated he/she prefer woman staff assistance and S1 never assist him / her for diaper change.

Continue 9099C

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220822142735

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: 09/01/2022

NARRATIVE

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Regarding allegation: Staff failed to meet resident’s diapering needs.

It was alleged that on 08/20/22 S1 didn’t assisted R1 for diaper change. R1 called S1 twice for help.

All interviewed staff including S1 stated that they do not refuse to assist the residents with diapering needs. S1 mentioned that some woman residents prefer to get assistance for diaper change from woman staff. R1 is one of them. R1 always get assistance from women staff for diaper change as she prefer. S1 stated that on 8/20/22 like other days he /she didn't refuse to assist R1 but any time that he/she is going to change R1's diaper R1 requesting to get assistance from woman staff. It will take a few minutes until woman staff will come to substitute S1 but R1 always will get an assistance with diaper change. S1 never refuse to assist R1 or other residents. R1 stated that S1 is nice with him/ her and when R1 called for assistance and it's S1 shift , S1 will call woman staff to assist R1. Interviewed Administrator and Assistant Administrator stated that facility always make an arrangements to meet residents needs, also diapering needs. They stated that staff change diapers for incontinent residents every 2 hours and as needed. Interviewed residents stated that staff always available to assist them with their needs if they require assistance. Staff comes and check on their incontinent needs too often, but understands they have a job to do.

Based on statements and interviews conducted with staff, residents there was not enough supportive evidence to concur with the reported allegations. 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.

Exit interview held, and a copy of this report was provided to the Administrator.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

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