198602950-9-7-2023-28-AS-RORN-CW2TEK-20230926144004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 09/07/2023
Date Signed: 09/07/2023 02:56:21 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
02/02/2022 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220202094921

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: 103	DATE:	09/07/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Teresa Saavedra - Receptionist		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Staff make inappropriate comments towards resident's
Staff are not meeting resident's hygiene needs
Staff are not meeting resident's laundy needs
Staff did not safeguard resident's personal belongings
Facility has an expired license posted

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegations listed above. LPA met with Teresa Saavedra the receptionist of the facility and explained the reason for the visit. The Administrator Lisa Pham arrived shortly thereafter.

The investigation consisted of the following: during the initial visit conducted on 02/10/2022, LPA Joe Katrdzyhyan interviewed two (2) Staff Members, five (5) Residents, and also obtained documents from Resident #1's (R1's) file. During today's visit, LPA Zaragoza reobtained the FACE Sheet, Preplacement Apprasials information, Physician's Report, and Admission Agreement for R1, and also obtained the Inventory List of Personal Items for Resident #1 - Resident #11 (R1 - R11), along with an updated Staff and Resident Roster list. LPA Zaragoza also interviewed Staff # 1 - Staff #8 (S1 - S8), and also R2 - R11. LPA attempted to interview R1, however R1 no longer lives in the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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 3

Control Number 28-AS-20220202094921

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: 09/07/2023

NARRATIVE

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The investigation revealed the following: in regards to the allegation "Staff make inappropriate comments towards resident's", it is alleged that staff at the facility yell at residents and have verbally harassed them in the past. During interviews with the residents, none of them could corroborate the allegations that they have been spoken to rudely or disrespectfully. R4 explained that the staff have been very courteous and nice to all the residents within the facility, and R7 stated that the staff treat the residents with total respect here and that they have never had any problems with the staff of the facility. During interviews with the staff members, none of them claimed to have witnessed staff at the facility verbally abusing any residents. Staff members explained that if any form of abuse were to occur then they would immediately report it to the administrator, and the Administrator stated the facility would then conduct an investigation into the allegation which would include interviewing residents and staff involved, creating and SOC341, and possible termination as well.

In regards to the allegation "Staff are not meeting resident's hygiene needs", it is alleged that R1 had gone without showering for 4 weeks, and that when they did get assistance with showering R1 was given half-body showers instead of a full-body shower. During interviews with the residents, none of them corroborated the allegation that staff were not providing showering assistance to residents who need it. R7 and R9 explained that they require assistance with showering, and that they always get assistance from the staff without any issues. During interviews with the staff members, none of them corroborated the allegation that the facility does not meet the resident's hygiene needs. S1 explained that residents who require assistance with showering always receive full body showers, and S1 along with S3, S5, and S7 explained that they follow a shower schedule to help assist residents with showering at least twice per week.

In regards to the allegation "Staff are not meeting resident's laundry needs", it is alleged that R1's laundry was not being done in a timely manner, and that a staff member told R1 that they did not have enough clothes to do R1's laundry. During an interviews with the residents, none of them could corroborate the allegation that their laundry needs are not being met. R4, R5, R7, R9, and R10 all explained that they get assistance with their laundry once per week, and that they have had no issues with their laundry being done in a timely manner. Interviews with staff revealed that a laundry schedule is followed to ensure all residents get assistance with their laundry, and the laundry staff S8 explained that they assist with doing the laundry for 66 out of the 80 resident rooms per week, while the other laundry staff members assist with the remaining rooms.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220202094921

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: 09/07/2023

NARRATIVE

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In regards to the allegation that "Staff did not safeguard resident's personal belongings", it is alleged that some of her clothes have gone missing while living at the facility. During interviews with the residents, eight (8) out of ten (10) residents could not corroborate the allegation. R4 explained that whenever they leave the facility for an extended period of time, the facility provides R4 a "vacation lock" which ensures that R4's room remains locked and that no other caregivers or residents can enter it besides R4 in order to protect his possessions from being stolen. None of the staff members could corroborate the allegation. S1 explained that if any residents report any possession to be suspected of missing or stolen, the facility works to identify the item, attempt to locate the item or the person in possession of the item to ask them to return it to the rightful owner, and file a police report as well if necessary. S2 - S8 all explained that they would report any allegations of items being stolen from residents to management.

In regards to the allegation that "Facility has an expired license posted", it is alleged that the facility's public health license had expired on 6/30/2021. During a tour of the facility, LPA observed that the administrator's certificate was posted in a prominent location near the facility's front office and was still current with an expiration date of 3/1/2024, and also noticed that the facility's license was prominently displayed as well. LPA was not able to get further clarification on which particular license was outdated at the time this complaint was field.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, 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 above allegations are UNSUBSTANTIATED.

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

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC9099 (FAS) - (06/04)

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