198602950-9-14-2023-28-AS-DSIS-CVSS87-20230918133836

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 09/14/2023
Date Signed: 09/14/2023 02:29:46 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
09/08/2023 and conducted by Evaluator Tena Herrera

COMPLAINT CONTROL NUMBER: 28-AS-20230908152213

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: 94	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Cynthia Flores - Assistant Administrator		TIME COMPLETED:	02:47 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility not providing residents with enough planned activities or variety of activities.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Cynthia Flores (Assistant Administrator) and Administrator Lisa Pham and explained the reason of the visit.

The investigation consisted of the following:
LPA requested copies of staff/resident roster, resident activity schedule for the last 3 months, toured the activity room, observed activities during visit, observed activity supplies, conducted Staff # 1-5 (S1-S5) and Resident # 1-9 (R1-R9) interviews.

The investigation revealed the following:
Allegation: Facility not providing residents with enough planned activities or variety of activities.
It is alleged that the facility does not offer enough activities for the residents, the activities offered are available only once a week and limited to bingo. (Continued on 809-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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-20230908152213

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LAKEWOOD PARK MANOR	FACILITY NUMBER: 198602950
	VISIT DATE: 09/14/2023

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

LPA toured the facility and observed Activity Schedule for the month of September posted throughout the halls, there is a Fitness room where the exercise activity is conducted in the mornings on the 2nd floor, an activity/family room on the 2nd floor and a Game Room on the 3rd floor. LPA observed board games and books in activity/game room that are readily available for residents. The supply for the art and crafts activities was also observed. 5 out of 5 staff interviewed stated that they have schedules with various activities for residents to engage in throughout the day/week that include, painting, jewelry making, coloring, table talk time (social engagement), exercise, going for group walks, movie afternoons (residents vote on movie), bingo, bored games, and others. Staff stated that when residents have ideas on new activities they review the activity and try to add it to the schedule. Staff stated the suggestion of residents going on field trips is difficult due to funds. LPA interviewed 9 Residents and 8 out of 9 residents denied the above allegation, some stated they do not participate in the activities as they choose not to socialize, however, they observe activities being conducted throughout the day and are announced on the intercom and in the dining area. Residents that do engage in activities stated that they have a variety of activities to choose from and feel the facility is providing as much as they can to the residents. All 9 residents stated that there are plenty of books, bored games, there is a pool table, radio, karaoke machine and TV they are able to utilize if they wish. Interviews and observation do not corroborate this allegation.

Based on statements and interviews conducted with staff and residents, along with observations, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

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

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2