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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602950
Report Date: 02/07/2024
Date Signed: 02/07/2024 12:04:50 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
06/28/2022 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220628152050
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: 116DATE:
02/07/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Assistant Administrator Cynthia FloresTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Resident sustained a fracture while in care
Staff did not seek timely medical attention for a resident
Staff did not ensure a resident was properly fed while in care
Resident's call light is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced subsequent visit in regards to the original complaint dated 06/28/2022.
The initial visit was conducted 06/30/22 and included the following:
Licensing Program Analyst (LPA) Glenn Trueman conducted a Health and Safety Check visit in response to the above mentioned allegations. LPA met with Administrator Lisa Pham and Assistant Administrator Cynthia Flores and explained the reason for the visit.

Investigation consisted of the following: LPA requested copies of Client & Staff Rosters and conducted a tour of facility at 12:50 PM along with Administrator Lisa Pham and Assistant Administrator Cynthia Flores which also included the common areas. LPA also reviewed and received copies from Resident #1's (R1) file. LPA observed the clients to identify any signs of neglect, abuse, or other immediate health and safety threats.
LPA did not observe any immediate health and/or safety concerns during today's visit. LPA observed a sufficient supply of perishable and non-perishable foods for the clients in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn TruemanTELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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-20220628152050
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: 02/07/2024
NARRATIVE
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Investigation was conducted by the Investigations Branch (IB) and completed 10/10/2022 for allegations Resident sustained a fracture while in care and Staff did not seek timely medical attention for a resident.
Investigation consisted of interviews with facility staff, nurse practitioner and review of medical documentation.
At today's visit at 10:30 AM LPA toured the facility with Assistant Administrator Cynthia Flores and inspected the call lites in Rooms 2, 6, 22, 45, 48, and 63.
Interviews were conducted at 11:00 AM with Resident's R 2- R7.
In regards to the allegation Resident sustained a fracture while in care, based on interviews conducted by the Investigations Branch( IB) and medical documentation reviewed it was revealed in interviews with staff that R 1 had told staff about unwitnessed falls. R 1 was assessed and staff did not observe any injuries, swelling or redness.
Staff still contacted R 1's doctor and R 1's Nurse Practitioner. The following morning at 0915 hours R 1 complained of minor pain and staff promptly contacted the Nurse Practitioner who stated in interviews conducted that there were no bruises/ swelling or redness.
R 1 was observed walking and did not complain of any pain.
Nurse Practitioner confirmed that staff acted accordingly and reported R 1's condition in a timely manner.
Nurse Practitioner also stated that she denied having any complaints or witnessing any Neglect/ Lack of supervision by facility staff.
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.
In regards to the allegation, Staff did not seek timely medical attention for a resident, , based on interviews conducted by the Investigations Branch( IB) and medical documentation reviewed it was revealed in interviews with staff that R 1 had told staff about unwitnessed falls. R 1 was assessed and staff did not observe any injuries, swelling or redness.
Even though R 1 was not complaining of any pain, and no bruises or swelling, staff immediately contacted Care More Health and requested a medical evaluation.
Per Nurse Practitioner the staff immediately notified her of R 1's reporting and condition.
Subsequently the Nurse Practitioner evaluated R1 and medically cleared R 1.
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.
In regards to the allegation Staff did not ensure a resident was properly fed while in care, based on interviews
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn TruemanTELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220628152050
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: 02/07/2024
NARRATIVE
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conducted with staff, and residents R 2- R 7 and information gathered all 6 of 6 resident's interviewed stated they are always fed and get all 3 meals and a snack and stated if a resident does not come to the dining room they will bring food to their room.
Interview with Assistant Administrator Cynthia Flores who stated that R 1 did get all her meals and if residents not feeling well they will bring to their rooms.
Also stated that R 1 is verbal and had a cell phone to communicate with staff if needed.
Staff S 1 stated that they will check in rooms if they are eating and also check in the dining room.
They make a list downstairs and check who has received their meals.
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.
In regards to the allegation, Resident's call light is in disrepair, based on resident and staff interviews conducted and tour of Rooms 2, 6, 22, 45, 48, and 63, it was revealed that all call lites were operable when tested by the LPA.
Staff responded to the call lite for assistance in a timely manner.
Interviews with staff who stated that the panel in the office lites up and the staff has a walkie talkie to communicate which room needs assistance. There is also a panel that lites up on each floor that will show which room needs assistance.
6 of 6 resident's interviewed stated that the call button works and the staff respond quickly.
Also stated it is easy to use and staff does a good job.
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.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn TruemanTELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3