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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 10/16/2023
Date Signed: 10/16/2023 03:53:34 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
10/06/2023 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20231006111645
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: 96DATE:
10/16/2023
UNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Cynthia FloresTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are not meeting residents needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced initial 10-Day complaint investigation regarding the above allegation. LPA met with Cynthia Flores who assisted with this visit.
Purpose of today's visit was explained.

The investigation consisted of the following: LPA obtained copies of Staff and Resident Rosters, Facility Policy of Personal Care and Admission Agreements, interviewed Assistant Administrator, Staff 1 to Staff 4 (S1 to S4), Resident 1 to Resident 7 (R1 to R7)

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023
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-20231006111645
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: 10/16/2023
NARRATIVE
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Investigation revealed the following: Regarding allegation: Staff are not meeting resident’s needs. It was alleged that facility have taken away residents’ haircuts and residents were told this week would be no more haircuts. RP stated that their concerned about residents in wheelchairs not being able to leave the facility to go get haircuts.

Interviewed Assistant Administrator and staff denied the allegation. During the interview with Assistant Administrator, LPA advised that facility provided haircut services to all residents’ long time ago, before pandemic. There was a hairdresser who came to the facility for all residents’ haircuts or other cosmetology services and residents or responsible parties paid for those services. Haircut or other cosmetology services not included in the basic services plan and on the admission agreements considered as a 3rd party services. Assistant administrator and interviewed staff indicated that facility residents including residents on the wheelchair very independent and they able to leave the facility without assistance. But if they need any assistance for outside services including a haircut, staff will assist them to make an appointment, walk with them or give a ride to get to hair salon and back. Interviewed staff also indicated that sometimes family members taking residents to hair salon to get the haircut. All interviewed residents denied the allegation. they stated that facility staff always assist them with hair cut services and never heard that staff said no more haircuts this week or any other days. Interviewed residents stated that staff always make an appointment for them for haircut or other services if they need it.


Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview held. A copy of the report was provided to Assistant Administrator.

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune MargaryanTELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023
LIC9099 (FAS) - (06/04)
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