198602950-9-14-2022-28-AS-DSIS-CWGNDP-20231010102238

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 09/14/2022
Date Signed: 09/14/2022 03:48:47 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
10/27/2021 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20211027151500

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:	09/14/2022
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Asst. Administrator, Cynthia Flores		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not communicate with resident promptly and appropriately
Financial abuse
Facility staff failed to keep resident's rooms clean
Facility staff failed to keep facility free from insects

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted a follow up complaint visit to render findings on the above allegations. LPA met with Assistant Administrator Cynthia Flores and explained the purpose of today's visit.

The initial investigation complaint visits were on 11/3/21 and 12/10/21. LPA Nicole Spencer took a tour of the physical plant and interviewed the Residents, Staff and reviewed residents and facility's records.

During today's visit, LPA took a partial tour of the facility and exercised strict mitigation measures due to the most recent Coronavirus Disease 2019 (COVID-19) outbreak this facility had. LPA re-interviewed the Assistant Administrator, interviewed two (2) more residents and collected a copy of the staff roster, resident roster, housekeeping/maintenance schedule and housekeeping deep cleaning schedule (Aug-Oct. 2021). LPA also obtained copies of the pest control service invoices, surety bond, and for three (3) specified residents: account balance ledger and resident fund management authorization form.

Continued on LIC 9099-C.......

Unsubstantiated

Estimated Days of Completion: Housekeeping

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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-20211027151500

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: 09/14/2022

NARRATIVE

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· Regarding allegation: Staff did not communicate with resident promptly and appropriately.
It was alleged that Administrator (A1) will not communicate with RP despite several attempts regarding RP's Social Security paperwork. Interview with Administrator revealed that residents’ concerns are promptly dealt with. Facility has suggestion and work order boxes that residents can use if they have concerns. A1 is not aware of this allegation. Asst. Administrator (A2) stated that if residents need assistance with SSI, she will do a 3-way call with the resident and SS office. A2 denied the allegation that she did not address a resident promptly or appropriately and has not heard of any residents with this complaint. Interviews with S1-3 revealed that they respond to residents’ concerns right away and have not had any complaints. They have not heard complaints about the staff not responding promptly or appropriately. Interview with S3 revealed that they deal with residents’ concerns promptly. S3 does not deal with SSI so she refers them to the Asst. Administrator and has not heard anyone complain about SSI. Seven (7) out of 12 Residents (R2, R4, R6-7, R9, R11-12) interviewed stated that Staff communicate with them professionally. Staff are nice and they have no issues or concerns. LPA observed staff/ resident interactions during the visit conducted on 9/14/22 and did not observe staff communicating inappropriately to any resident. LPA observed the interactions to be respectful. Therefore, there was insufficient evidence to corroborate with this allegation.

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

· Regarding allegation: Financial abuse
Administrator stated that A2 deals with all the residents finances and is not aware of any financial abuse. A2 is working with RP and assisting with his money. A2 stated that she is not aware of any residents who are having this issue. A2 stated that the payees are given their allowance in the beginning of the month. S3 stated that A2 deals with all the finances and not aware of this allegation. Nine (9) residents (R2-6, R9-12) out of 12 residents revealed that they either handle their own money. Some also stated that their SSI money are handled by a family member and they have no issues or knowledge of financial abuse in the facility. R2 and R10-12 stated that their SSI money get deposited to their checking account and have no concerns about that. R3 stated that facility gives him $138/mo. for spending. LPA reviewed some resident's records and did not find any discrepancies.

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

CONTINUED ON LIC 90999-C........

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20211027151500

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: 09/14/2022

NARRATIVE

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· Regarding allegation: Facility staff failed to keep resident's rooms clean
Interview with Administrator (A1) and Asst. Administrator (A2) revealed that housekeeping is done daily, and room checks (taking out trash, replacing paper products) are completed daily with the deep cleaning done once a week. A1 stated that if resident has an issue with the cleaning, A1 will have housekeeping do it again. A2 stated that housekeepers clean the resident’s rooms at various times throughout the day. A1 and A2 have not heard of any residents complain about this issue recently. Interviews with Staff 1-3 indicated that housekeeping staff are providing housekeeping services (cleaning and rooms checks) daily. Deep cleaning services are done on a weekly basis. Interviews with nine (9) out of 12 residents stated that housekeeping cleans and do a very good job. Housekeeping checks the rooms every day and do a thorough job. LPA reviewed the facility's housekeeping/maintenance schedule and housekeeping deep clean schedules and duties for Aug-Oct 2021 and revealed that they have staff assigned to clean the resident's rooms daily and deep clean on a weekly basis. Therefore, there was not enough supportive evidence to concur with the reported allegation.

Based on LPA's observations, interviews and record reviews, investigation revealed: Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED.

· Regarding allegation: Facility staff failed to keep facility free from insects
Interview with Administrator (A1) and Asst. Administrator (A2) revealed that they have not seen any bugs or heard of residents complain about bugs. A1 stated that RP has a plant in the room that attracts gnats. But housekeeping do maintenance sprays in the area once a week and pest control technicians come in monthly to service the facility. A2 stated that they do not have any insect problem and they take preventive measures. Some residents eat in their room that have attracted bugs and insects. Interviews with S1-3 indicated that they have not seen any bugs in the facility and heard of anyone complain of this issue. Interviews with eight (8) out of 12 residents (R2-7, R11-12), stated that they have not seen any bugs or gnats or heard anyone else with this issue. R3 stated that he used to see bugs about a year ago but not anymore. LPA Spencer toured the facility on 12/13/2021. LPA checked the common areas and five (5) resident rooms and observed that four (4) out of the five (5) resident rooms checked did not have bugs or gnats.
During today's visit, LPA Pena inspected three (3) rooms and common areas and did not observe bugs or gnats in their rooms or bathrooms, including shower curtains. LPA reviewed the facility's pest control invoices and revealed that the pest control company serviced the facility in Aug, Sep and Oct. 2021.

Based on LPA's observations, interviews and record reviews, investigation revealed: Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted and copy of the reports were provided to Asst. Administrator, Cynthia Flores.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC9099 (FAS) - (06/04)

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