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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 10/09/2023
Date Signed: 10/09/2023 01:35:44 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
10/27/2021 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211027151500
FACILITY NAME:LAKEWOOD PARK MANORFACILITY NUMBER:
198602950
ADMINISTRATOR:LISA PHAMFACILITY TYPE:
740
ADDRESS:12045 LAKEWOOD BLVDTELEPHONE:
(562) 923-4417
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:160CENSUS: 92DATE:
10/09/2023
UNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Cynthia Flores - Asst. AdministratorTIME COMPLETED:
01:00 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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** This report supersedes the original complaint investigation report dated 9/14/2022 to include additional information. Investigation findings on this report remain the same, UNSUBSTANTIATED.**

Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint visit and deliver findings to the superseded reports for the allegations listed above. LPA met with Assistant Administrator Cynthia Flores and explained the purpose of today's visit.

The initial investigation complaint visits were on 11/03/21 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 the subsequent visit on 9/14/2022, LPA Pena 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.

During today’s visit, LPA Pena obtained copies of the resident & staff rosters, housekeeping/maintenance schedule (Aug-Sep 2023), pest control service invoices (Aug–Sep 2023), PNI record for R1 (Feb 2021-Oct 2021) as well as random residents (Aug-Sep 2023). LPA interviewed additional residents and staff, Resident #13 (R13) – Resident #17 (R17) and Staff #4 (S4) - Staff #5 (S5). LPA also conducted a tour of the facility’s common areas and (6) random resident rooms in the 2nd and 3rd floors (Room #s 5, 17, 28, 33, 63 and 64). *****CONTINUED ON LIC9099-C*****
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
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-20211027151500
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: 10/09/2023
NARRATIVE
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*****This report supersedes the original complaint investigation report dated 9/14/2022 to include additional information. Investigation findings on this report remain the same, UNSUBSTANTIATED.*****

  • Regarding allegation: Staff did not communicate with resident promptly and appropriately.
It was alleged that staff will not communicate with the resident despite several attempts regarding the Social Security paperwork. An interview with the A1 revealed that she is not aware of this allegation. A1 stated that the residents’ concerns are promptly dealt with. The facility has suggestion and work order boxes that residents can use if they have concerns. Interview with A2 who denied the allegation indicated that if residents need assistance with SSI, she will do a 3-way call with the resident and SS office. A2 denied not addressing a resident promptly or appropriately and has not heard of any residents with this complaint. Interviews with staff revealed that they respond to residents’ concerns right away and have not had any complaints about the staff not responding promptly or appropriately. Staff members also stated that they deal with residents’ concerns promptly. (12) out of (17) Residents interviewed stated that staff communicate with them professionally. Other residents stated that the staff are nice, and they have no issues or concerns. LPA observed staff/ resident interactions during the visits conducted on 9/14/22 and 10/09/2023 and did not observe staff communicating inappropriately to any resident. LPA observed the interactions to be respectful. Staff interviews, resident interviews and reviewed documentation do not corroborate this allegation.
  • Regarding allegation: "Financial abuse." It is alleged that R1 has not received his PNI allowance in
about 7 months. It is also alleged that R1 never received his stimulus check money, and his roommate has also had this issue. Interview with A1 revealed that A2 deals with all the residents’ finances and is not aware of any financial abuse. A2 is working with R1 and assisting with his money. A2 stated that R2 manages his own SSI money/finances. A2 also stated that she is not aware of any residents who are having this issue. A2 stated that the payees are given their allowance at the beginning of the month. S3 stated that she is not aware of this allegation, has not heard anyone complain about SSI and does not deal with SSI. (15) out of (17) residents interviewed stated that they don’t have any concerns, issues, or knowledge of financial abuse in the facility. Other residents indicated that they handle their own money, or that their SSI money is handled by a family member. (4) out of (17) residents stated that their SSI money gets deposited to their personal checking account and they have no concerns. Some residents also stated that the facility gives them their monthly allowance to spend. LPA reviewed R1's SSI PNI records (Feb 2021-Oct 2021) plus (5) random SS1 PNI records (Aug 2021-Oct 2021) and LPA did not observe any discrepancies. LPA observed that R1 received his stimulus check on 4/07/2021. All the residents SSI PNI records reviewed by LPA showed the SSI funds with corresponding debit and credit entries. Staff interviews, resident interviews and reviewed documentation do not corroborate this allegation.

*****CONTINUED ON LIC9099-C*****
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: LAKEWOOD PARK MANOR
FACILITY NUMBER: 198602950
VISIT DATE: 10/09/2023
NARRATIVE
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*****This report supersedes the original complaint investigation report dated 9/14/2022 to include additional information. Investigation findings on this report remain the same, UNSUBSTANTIATED.*****

  • Regarding allegation: “Facility staff failed to keep resident's rooms clean.”
It is alleged that staff used to clean R1’s room but lately in the last couple of months has only been taking out the trash and changing the sheets and that's all. Interviews with staff members 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 a 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. Staff members have not heard any residents complaining about this issue recently. Interviews with staff indicated that housekeeping staff provide housekeeping services (cleaning and room checks) daily. Deep cleaning services are done on a weekly basis. (15) out of (17) residents stated that housekeeping cleans often and does a very good job. Housekeepers check the rooms every day and do a thorough job. LPA reviewed the facility's housekeeping/maintenance schedule as well as housekeeping deep clean schedules and duties for (Aug 2021-Oct 2021) and (Aug 2023-Sep 2023). The documents revealed that they have staff assigned to clean the residents’ rooms daily and deep clean on a weekly basis. Therefore, there was not enough supportive evidence to concur with the reported allegation.
  • Regarding allegation: “Facility staff failed to keep facility free from insects.”
It is alleged that R1 has had an issue with gnats in his room for quite a while, especially in the bathroom. Interviews with staff revealed that they have not seen any bugs or heard of residents complaining about bugs. A1 stated that R1 has a plant in the room that attracts gnats. But housekeeping does 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 problems and they take preventive measures. Interviews with staff members indicated that they have not seen any bugs in the facility and heard of anyone complaining about this issue. (13) out of (17) residents stated that they have not seen any bugs or gnats or heard anyone else about this issue. Some residents indicated that they eat in their rooms that may have attracted bugs and insects. LPAs toured the facility on 11/03/2021, 12/13/2021, 9/14/2022 and 10/09/2023. On 11/03/2021 and 12/13/2021, previous LPA observed gnats in the common areas and in (1) out of (5) rooms. However, LPA Pena did not observe bugs or gnats in the common areas and total of (11) random residents’ rooms or bathrooms during the visits on 9/14/2022 and 10/09/2023. LPA reviewed the facility's pest control invoices for (Aug-Oct 2021) and (Aug-Sep 2023) and observed that the facility continues to have regular pest control services. Therefore, there was not enough supportive evidence to concur with the reported allegation.

Based on statements and interviews conducted with staff, residents, review of resident 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 allegations are UNSUBSTANTIATED.

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

SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3